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0 0 <br /> LUCKY <br /> TATTOO, LL_---E <br /> 181 W.Alameda Street,Manteca CA 95336 <br /> C <br /> (209) 629- 8321 <br /> NAME: CELL: <br /> ADDRESS: ZIP: <br /> PLEASE READ:After your tattoo is comp ted,you will be provi d, rcare instrustions.It is extremely Important that you <br /> follow all instrustions t ure proper h ling of your tattoo.Faltt:` w all Instructions may resul nfection or <br /> fading of your es L►e tion of the skin � ents permenantly. atment <br /> sa <br /> as a result, dure or y even, � th' roced cost. <br /> PLEASETFE FO <br /> Are or older? o_ <br /> Have ever been tattooed No_ <br /> Are y Hemophiliac or have arty ding <br /> Are y underthe infiuenc ol? <br /> Are yo pregnant or nursl ? o_ <br /> Dayou ve epilepsy? No <br /> Ar6you a tic? Flo <br /> Do you have,HI <br /> Have you ever been diagnosed ? No <br /> Do you have a history of her " dure sight? <br /> Are you allergic to late <br /> Do you .� <br /> Do,you awe Iti actions to latex? Yes <br /> Do you have a hsor�� eases Ye <br /> Do you have requirements r ery.or rfu� No_ <br /> Are you on medication? t: <br /> Do you have any risk factore for pathogens?:' No <br /> If,yes:description/location.. <br /> PLEASE INITIAL THE FOLLO O <br /> I understand that tattoos and pe <br /> I agree to follow all aftercare l ns given to me by <br /> I understand that certain skirtto 3ke color differentia, <br /> I understand that the pigmen**re kQDA approved a � known <br /> I underrstand that there are NO REFUNDS ON TA <br /> understand there can be some d' , � ollowing this p ,y <br /> ASSUMPTION OF RISK,REL EAS IFICATION: <br /> I, under t l"d n een fully informed of, cleated with receiving a permenant <br /> Ink tattoo.I consent to receive a tattoo and d all risks and sr release,defend,indemnify and hold <br /> harmless,LUCKY YOU TATTOO LLC,and It's agent,e ,offic " ist,contractors,members,heirs,or <br /> assigns(hereinafter all referred to as LUCKYYOU CAI fr nown,or unknown,past,present,or future, <br /> claims,demands,rights,liabilities,damages and ca arising under any theory or liability,(including <br /> breach of contract,tort,statutory,or regulatory violati involving or related In any way,to the tattoo that I will <br /> receive from LUCKY YOU TATTOO,LLC. <br /> ACKNOWLEDGE AND AGREED TO:Signature <br /> r <br /> Date: <br /> Artist- Cost: <br />