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• 0 <br /> Do you have any medical or skin conditions that may affect the outcome of your tattoo? <br /> Is there any other information you feel you should provide the body art <br /> practitioner? <br /> Waiver and Release <br /> Int. 1. To my knowledge,I do not have any mental or medical impairment or disability <br /> which might affect my well-being as a direct or indirect result of my decision to have any tattoo <br /> i <br /> d/or iercing procedure done at this time. <br /> ii <br /> 2. I agree to follow all instructions concerning the care of my tattoo and/or piercing <br /> while it's healing. I agree that any touch up work, due to my negligence,will be done at my own <br /> expense. <br /> Int. 3. I understand that if my skin color is dark,the colors will not appear as bright as <br /> they do on lighter skin. Additionally, I understand that the finished tattoo may vary somewhat in <br /> appearance,color and/or design from the paper or other drawing or photographic image which the <br /> tattoo design is based. <br /> Int. 4. All questions about the procedure have been answered to my satisfaction, and I <br /> have been given written aftercare instructions for the procedure I am about to receive. <br /> Int. 5. I am the person on the I.D. presented as proof I am at least 18 years of age. <br /> Int. 6. 1 have been advised that the tattoo will be permanent and that it can only be <br /> removed with a surgical procedure, and that any effective removal will leave permanent scarring <br /> and disfigurement. This cautionary notice is required to be provided to me by the health <br /> department and I hereby acknowledge receipt of this formal notice. <br /> Int. 7. I understand there is a risk of an allergic reaction and agree not to hold Colorful <br /> Addictions responsible for any allergic reactions. <br /> Int. 8. I am not under the influence of drugs or alcohol and that I am voluntarily <br /> submitting to be tattooed without distress or coercion. <br /> Int. 9. I understand tattoo inks are not FDA approved and health consequences are <br /> unknown. <br /> Int. 10. I swear or affirm and agree that the above information is true and correct. <br /> I have been provided with information describing the tattoo and/or piercing <br /> procedure to be preformed and instructions on after care. I understand it is my <br /> responsibility to take care of my new tattoo and/or piercing site according to the <br /> instructions provided both verbally and in writing. I have been fully informed of the risks <br /> of tattooing including but not limited to infection, scarring, difficulties in detecting <br /> melanoma, and allergic reaction to tattoo pigments, latex gloves and antibiotics. Having <br /> been informed of all potential risks associated with getting a tattoo, I still wish to proceed <br /> with the tattoo procedure and I assume any and all risks that may arise from tattooing. <br /> Customer Signature Date <br /> DO NOT WRITE BELOW THIS LINE <br /> Tattoo Information <br /> Description of tattoo Exact spelling of names or <br /> words <br /> Location on body Price of tattoo <br /> Artists Name Artists <br /> Signature <br />