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0 0 PERMANENT BODY ART CONSENT RELEASE FORM NAME: DOB:_ LICENSE#: ADDRESS: CITY: STATE: ZIP CODE: PHONE#: DESCRIPTION OF TATTOO: I, acknowledge by signing this release form that I have been given the full opportunity to ask any and all questions I might have about obtaining a tattoo from NEW LIFE TATTOO STUDIO. I acknowledge that all my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth below, and I agree as follows: I am not under the influence of alcohol or drugs. I do not have acne, freckles, moles, or sunburn in the area to be tattooed that might be agitated by the tattoo process. I have looked over my design, checked the spelling if applicable, and give my full consent to the application of my tattoo. 1 acknowledge that I am not pregnant. I acknowledge that I am free of communicable disease. I acknowledge that I have truthfully represented to the associates, agents and representatives of NEW LIFE TATTOO STUDIO that I am over eighteen (18) years of age. I acknowledge it is not reasonably possible for the associates, agents and representatives of NEW LIFE TATTOO STUDIO to determine whether I might have an allergic reaction to the dyes, pigments, or processes used in my tattoo and I agree to accept that such risks are possible. I acknowledge that infection is always possible as a result of obtaining a tattoo particularly in that event that I do not take proper care of my tattoo, and I have been advised of the signs and symptoms of infection that indicate a need to seek medical care. 1 acknowledge receipt of written instructions advising me of proper care of my tattoo and recognize the absolute necessity of following those written instructions. All questions about the body art procedure have been answered to my satisfaction.