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Flawless Ink arkle BY nicholette Vonmnteca# Ca 95336 227 N Mai(209)n St 407-7- 7274 release and waiver 0f all claims which 1 to ask any and all questions ermanent makeu (here after calling Consent to the Toll opportunity givingbeen signing this release aha make'uP from eyed to my full and total satisfacti°n• anently I acknowledgeab by uestions have been answ might have aboutobtaining and tthat all my 4 as follows: ++technician") h below an agree to be Performed a matters set fort procedures been advised of th [ 1 have anent make-up wtllre the acknowledged the t the ability to 1 specifically It cationveshav� hotce alone and the aPP Senmdveshav been made to me as lnllkdhng; perm rnyc into mYa In.No reprc t make-up is thave epilepsy. acknowledge that obtain and thatneedles and inlrs wr.1 ,million. dare siteldono rfrom any I mance, nentmake-uP to the engine co Prot diacvalve disease or suffe � changeto YIvea , fherpes infections att1 dP°Behave �r permanen inn involvedm Pe history ° bleeding disorders. l do no d m later restore the s nathave any Ihave Informe r ant or Tat t lotics,hema ilia or other orounicable diseasefmy Filial lamrnr ace urs load. ore or other to healing ° �leT c e uonto latex °ratth' thogen expos mote the satisfactory diabetes, dations or take medication dares necessary Pro beam con [her riskfofanyf rbcal andpro a to Psoriasis at the side of CroCtt at itis, oro ruoPbfcsca"" ' Pse If suffer factthat havebeen advised ofa 1' tnedic 'an of the the Terlinta suchas,b arh°ted tic of YPe prior to dental or make-uP• medical or a' at the prescribed anttbiottcs t the site of the proceduretncluding being P i donors , m r [toaoyopenwri or lesionsa using medication+ ssibe for permanent nena t make-uP, or arty Pon unendy ge it is tai r knowledge that such P at° ofinedicafion use ort owled loves. so for medicaactIrlo lure and further ackno I do nothaveahi ry dotes. Ihave any allergies to `stn oche Pe mcosmenc grace drugs or surgical scat PSOce eller rnrane fluence of any Ihave advisedtheTeco n I lithaveallergic rest f° the to llbeb`g as a direct or ld of age or older. lam not under we � • to determine whe dratmaY affeccmy the"i'echnicran possible, terEnStian thatimadl 'Q8iM rrtor disability reactions is esentveanyrP l men proc,dureah paime- t ndl agreed to follow all suggested Ihas etrutbfullfre notha hYsica + uretic ° dare at tills time. � knowledge, have aperrianenterr [ make-uPapplicaton, a alcohol.TO my decision to rmanen for marketing and. °T sways Possible as while tt6h aling• I db ctresuhofrny ermanentmake-uP(s) acknowledge Snfectfonse anentmak-trP to use images ofmyp I thecareoff keup stadia anted m television etc, dthat instructions concerning this Porotanentma 1 neabi, pr techmques.l understand to nd givecousentm Internet, tuagaztne, socia is and sterilizatmn Id harmless. the I acknowledges die such as tied app ° trumen and tcleare pub an Putposesinvarfous me and all claims ofne I Bjumype�uanent cos r priate ins r t makeup aPP ie emrelease and fo ever discharge, a tt nce, damage , tl Tnumen longer I ' toheal• l agree o psrvdin from anydure, and conductusf ng _I ^nderstandlwillhave Po zweeks ornentma a-nlsin the Proce tmake-up site usually mem gemento£ th o�'onntmake-uPco rmanemprocedure. dand Drug the Peim e ntractors+ an tedinany um with Po t thispe it by the federalpoo sl w Y made consenting ° PProve all emp °I mg from cermet mems have notbeena Stu don ansing uo"k omatill tyfor the decisions) and Prg assume a tic inks, dyes, are unknown, and ass entcMare theseproducts I am aware about the Perm"nsequences of using tie ad tious and that the heal AGE: NAME+ yP PHU1't8: STATE:- ADDESS' GiT1: SIGNATURE: USED: T�hnician information on)y: PIGMENT TION: EXP1M EQUIPMENT USED: LOT OR MODBL NUMBERS: