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APPOINTMENT DATE: APPOINTMENT TIME: _ i OUN 306 a-41 St 1'r11ev. Ga 95376 094354413 TATTOQCrPIERCING R�LE�iJ�'FORAI I hereby initial to waive & release Blue Moon, for all and any Liabilities and therefore agree not to sue for all or any iabilities, including any personal injury, or claim ofki any kind which here after occur to me as result of participation In any o the. Permanent Cosmetic Make -Up or BodyPiercingb virtue of sections 1542 of the California Civil Code. This rule applies t following persons and entities those that may work as an Agent, Corltractor, Director, Representative, Employee or Unpaid volunteer, Gi Blue Moon; this release applies to the following person and entities those that may work written and or printed media advertisements. ;n addition to this release, I agree not to hold the persons and entities mentioned above responsible for any and all liabilities or claims mane b other individuals as a result of my actions during. and after any Tattoo or Body Piercing procedure or Service. I have read this release; rolm and fully understand the content of this form. r I hereby certify with ny initials that I am physically fit and that I feel sufficient to have this Tattoo or Body Piercing service performed. I do not have any communicable diseases such as AIDS/HIV, Hepatitis C, Hepatitis B, or Tuberculosis. In this release, I am certifying that I am not pregnant, or under the influence if any substance including alcohol. l am not a diabetic or if I am, I have informed tbl Tattoo Artist or Body Modifier of this fact. I acknowledge that there is a non-refundable (Permanent Make-up, piercing or tattoo), non transferable minimum deposit of $50 required for all Service Appointments. I have read and understand this release without a question W release Blue Moon of anytall reliabilities, I declare under penalty of perjury that the information I have provided is true and correct Al'W) when I sign the Guardian Section of the release form, I declare under penalty of perjury that I am the true guardian of the minor and will Ir.I hold Blue moon accountable in ANY shape or form. O Age_DOB^I_/ City State Zip Code Email (optional) Signature Guardian Signature_..___- _._...__... . I Testify That I am The Legal Guardian of the person getting the service. COM IA C#iEC4t£D Please have ID Present ' I'IERCIIYG Service $ Jeweh�• Cost $ TATTOO COST_ $ TT00 DCPOS[TE_$ ¢ALANCE DUE _ $_ NOTICE TAT'f00 INK.DYES'AND PIGMENTS FI;>VF: NOT BEEN APPROVED BY THE f EDFRAL FOGD AND DRUG . ..._ ..... ........ ..... •... , -„� • .-...,.�.�.., n-.v•rc ,ir i .c i�ir. ri_r r..cc onrl nl If TC t�RF I INKNOW.