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SECRET <br /> CONSENT FORM <br /> N DA <br /> DO LICENSE <br /> ADD <br /> CrIT <br /> STATE ZIP _CELLPH0NE tI <br /> I adm owledge by ftung this agreement that I have been g " eh tiie fifflopportunity <br /> to ask-any and all question which.I might have about the o i`g of a tattoo and. <br /> of'iny questions have n answered to MY M-satisiklion. <br /> if I have any condition that mig ht affect the beating of tift tattoo,I Will <br /> a `se my tattoo artist.I am not pregnant or n I am not der <br /> the influence of alcohol or drugs. <br /> y I do not have medial or shin condition such as bui-not limited to- <br /> ac <br /> o; <br /> acne,scarrigg(Keloid) eczema,psoriasis;. r es,mobs or sun bum <br /> in the area to be taftooed tnatmay interfere with said tattoo.If I have <br /> any type of.infbetion orlt.;;;A'anywhere onmy body,I will advise my <br /> artist <br /> • I acknowledge it is not reasonable possible for the representatives <br /> and employees of this tattoo shop todetermine whether I might have <br /> an allergic reaction to the pigaments or processes used in my tattoo, <br /> and I agree to accept the risk that such a reaction is possible. <br /> • I've been informed that currently the ink used in my tattoo is not FDA <br /> approved and health consequences are unknown- <br /> 1 <br /> own.I acknowledge that infection is always possible as a result of the <br /> obtaining of a tattoo,particularly in the event that.1 do nottake proper <br /> care of my tattoo.I have received after care instructions and I agree to <br /> Quo N/+1M <br />