Laserfiche WebLink
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 /> and/or piercing procedure done at this time. <br /> Int. 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. 3.1 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.I have been advised that the tattoo/piercing will be permanent and that it can only <br /> be removed with a surgical procedure,and that any effective removal will leave permanent <br /> scarring 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/pierced 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 this procedure including but not limited to infection, scarring, difficulties in detecting <br /> melanoma,and allergic reaction to tattoo pigments, latex gloves and antibiotics. <br /> Following the tattoo/piercing the area may be sore and have some redness.Also during <br /> healing may experience some itching and peeling. If any indication of infection such as <br /> fever,puss or extreme pain please seek medical attention. Having been informed of all <br /> potential risks associated with getting a tattoo/piercing, I still wish to proceed with the <br /> tattoo/piercing procedure and I assume any and all risks that may arise from this <br /> procedure. <br /> Customer Signature Date <br /> Parent/Guardian 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 />