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-1 acknowledge tha ariations in color and design may exist between any tattoos as <br /> selected by me and as ultimately applied to my body. <br /> 1 acknowledge that tattooing is a permanent change to my appearance and that no <br /> representations have been made to me as to the ability to later change, alter or remove <br /> my tattoo. <br /> 1 acknowledge that the obtaining,of my tattoo is my choice alone and I consent to <br /> the application of the tattoo and to any actions or conduct of the associates, agents or <br /> representatives of NEW LIFE TATTOO ST DIDIO,that are reasonably necessary to <br /> perform the tattoo procedure. <br /> I agree to release and forever discharge and forever hold harmless NfW LffE <br /> S'i'l ID10 and its associates, agent's officers and shareholders from any and all <br /> claims, damages, or legal actions arising from or connected in any way with my tattoo or <br /> the procedures and conduct used to apply my tattoo and any and all tattoos applied by <br /> NEW LIFE 0 STUDIO and its associates, agents and representatives in the <br /> future. <br /> 1 acknowledge that tattoo inks, dyes and pigments have not been approved by the <br /> federal Food and Drug Administration and the health consequences of using these <br /> products are unknown. <br /> 1 acknowledge that there is a chance i might feel lightheaded, dizzy during or after <br /> being tattooed. I agree to immediately notify the practitioner in the event 1 feel <br /> lightheaded, dizzy and/or faint before, during or after the procedure. I agree to follow all <br /> instructions concerning the care of my tattoo, and that any touch-ups needed because <br /> of my own negligence will be done at my own expense. <br /> 1, have been fully informed of <br /> the risks of tattooing including but not limited to infection, scarring, difficulties in <br /> detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, and <br /> antibiotics. Having been informed of the potential risks associated with getting a tattoo, I <br /> still wish to proceed with tattoo application and I assume any and all risks that may arise <br /> from tattooing. <br /> If single-use presterilized equipment Is used please provide Lot/ID number. <br /> SIGNATURE: <br /> DATE: <br /> LottlD : <br /> NEW LiFE TATTOO STUDIO <br /> 3414 DELAWARE AVE <br /> STOCKTON, CA 95204 <br /> (209)405-8951 <br />