Laserfiche WebLink
MODEL CONSENT TO APPLICATION OF <br /> PERMANENT COLOR OR PIGMENT REMOVAL PROCEDURE <br /> NAME DOB <br /> ADDRESS <br /> CITY STATE ZIP _ <br /> HOME PHONE. WORK PHONE <br /> I, am over the age of 18, am not under the influence of drugs or _ <br /> alcohol and consent to be a model for the following student: <br /> for the purpose of learning the following procedure: <br /> The general nature of cosmetic tattooing as well as the specific procedure to be performed <br /> has been explained to me and I understand work is from a student. <br /> I certify I have read and initialed the above paragraphs and have had explained to my full - <br /> understanding this consent and procedure permit and I will not hold the school or the <br /> following student: responsible for any unforeseen <br /> condition arising out of the indicated permanent cosmetic procedure. <br /> SIGNED: _ <br /> MODEL: DATE <br /> STUDENT: DATE <br /> TEACHER: DATE - <br />