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WAIVER&LEASE, AND CONSENT T*kTTOO I PLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING THIS DOCUMENT IS TWO PAGES. PLEASE INITIAL EACH PROVISION ON THE LINES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION. In consideration of receiving a tattoo from Robert Fredericksen at"The Raven Tattoo &Art Gallery" (together with it's employees, apprentices, and agents), I agree to the following: That 1, (clearly PRINT your name)have been fully informed of the Inherent risks, associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to Injury, including, but not limited to infection,scarring, difficulties detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been Informed of the potential risks associated with getting a tattoo, I still wish to proceed with the tattoo application and I freely accept and I expressly assume any and all risks that may arise from tattooing. TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and Tattoo Studio from all liability whatsoever, for any and all claims or causes of action that 1, my estate, heirs, executors,or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the application of my tattoo, whether caused by negligence or fault of either the Artist or the Tattoo Studio, or otherwise. That both the Artist and Tattoo Studio have given me the full opportunity to ask any and all questions about the application of my tattoo, and all my questions have been answered to my total satisfaction. The Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it Is healing,and I understand them and will follow them. I acknowledge that it is possible that the tattoo can be become infected, particularly if I do not follow the Instructions given to me. If any touch-up work to the tattoo Is needed due to my own negligence, I agree that the work will be done at my own expense. I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Artist without duress or coercion. Mark any medical history that would apply — History of herpes infection at the procedure area — History of diabetes — Allergy to latex — Allergic reaction to antibiotics — Hemophilia or other bleeding disorders — Cardiac valve disease — Requirements for antibiotics prior to surgery or dental procedures — Current medication — Other risk factors for blood borne pathogens