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TATTOO CONSENT RELEASE FORM 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 fattoo from . 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 (healing excluded).' ' I have looked over my design, checked the spelling if applicable, and give my full consent to the application of my tattoo. I acknowledge that I am not pregnant. I acknowledge that I am free of com a �nunicabl. disease. I acknowledge that I have truthfully represented to the associates, agents and representatives of that I am over eighteen (18)years of age. I acknowledge it is not reasonably possible for the associates, agents and representatives of 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. I acknowledge receipt of written instructions advising me of proper care of my tattoo and recognize the absolute necessity of following those written instructions. I acknowledge that variations in color and design may exist between any tattoos as selected by me and as ultimately applied to my body. I acknowledge that tattooing is a permanent change to my appearance and that no representations have been madeto me as to the ability to later change, alter or remove my tattoo. I acknowledge that the obtaining of my tattoo is my choice alone and I consent to the application of the tattoo and to any actions or conduct of the associates, agents or representatives of that are reasonable necessary to perform the tattoo procedure. I agree to release and forever discharge and forever hold harmless associates, agents officers and shareholders from any and all claims, damages, or leg Ind s actions arising from or connected in any way with my tattoo or the procedures and conduct used to apply my tattoo and any and all tattoos applied by its associates, agents and.representatives in the future. and have been fully informed of the risks of tattooing including but not limited to infection, scarring, difficulties in detecting melanoma, and allergic reactions to tattoo pigment, latex gloves,aand antibiotics. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with tattoo application and I assume any and all risks that may arise from tattooing. Signature: _ Date: If single-use pre sterilized equipment is used please provide Lot/ID number. Artist: Lot/ID #: v