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0 0 <br /> TATTOO CONSENT RELEASE FORMA <br /> I acknowledge by signing this release form that I have been given the full opportunity to ask any and <br /> all questions 1 might have about obtaining a tattoo from . I acknowledge that all my <br /> questions have been answered to my full and total satisfaction. I specifically acknowledge that I have <br /> been advised of the facts and matters set forth below, and I agree as follows: <br /> I am not under the influence of alcohol or drugs. <br /> I do not have acne, freckles, moles, or sunburn in the area to be tattooed that might be <br /> agitated by the tattoo process (healing excluded). <br /> I have looked over my design, checked the spelling if applicable, and give my full consent to <br /> the application of my tattoo. <br /> I acknowledge that I am not pregnant. <br /> I acknowledge that I am free of communicable disease. <br /> I acknowledge that I have truthfully represented to the associates, agents and <br /> representatives of that I am over eighteen (18) years of age. <br /> I acknowledge it is not reasonably possible for the associates, agents and representatives <br /> Of to determine whether I might have an allergic reaction to the dyes, <br /> pigments, or processes used in my tattoo and I agree to accept that such risks are possible. <br /> I acknowledge that infection is always possible as a result of obtaining a tattoo particularly in <br /> that event that I do not take proper care of my tattoo. <br /> I acknowledge receipt of written instructions advising me of proper care of my tattoo and <br /> recognize the absolute necessity of following those written instructions. <br /> I acknowledge that variations in color and design may exist between any tattoos as selected <br /> by me and as ultimately applied to my body. <br /> I 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 my <br /> tattoo. <br /> I acknowledge that the obtaining of my tattoo is my choice alone and I consent to the <br /> application of the tattoo and to any actions or conduct of the associates, agents or <br /> representatives of that are reasonable necessary to perform the tattoo <br /> procedure. <br /> I agree to release and forever discharge and forever hold harmless and its <br /> associates, agents officers and shareholders from any and all claims, damages, or legal <br /> actions arising from or connected in any way with my tattoo or the procedures and conduct <br /> used to apply my tattoo and any and all tattoos applied by and <br /> its associates, agents and representatives in the future. <br /> I, have been fully informed of the <br /> risks of tattooing including but not limited to infection, scarring, difficulties in detecting <br /> melanoma, and allergic reactions to tattoo pigment, latex gloves, and antibiotics. Having <br /> been informed of the potential risks associated with getting a tattoo, I still wish to proceed <br /> with tattoo application and I assume any and all risks that may arise from tattooing. <br /> Signature: Date: <br /> If single-use pre sterilized equipment is used please provide Lot/ID number. <br /> Artist: Lot/ID #: <br /> K tattoo docsslBodyArLSampleTattooConsentReleaseForm.doc Rt 71W12 <br /> SAMPLE FORM <br />