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INFORMED CONSENT TO BODY ART WORK <br />In cor side-ation cf receiving BODY ART from <br />ar. Practitioner at M JDVILLE TAT2 STUDIO. <br />(toget-ier with its err ployees, apprentices of "Mudville tat2 Studio") <br />applicable item. <br />the body <br />confirm the following by initialing each <br />_ All quest ons about the Body Art work have been answered to my satisfaction, and I have been given written <br />and verbal aftercare instructions fcr the Body Art work I am about to receive. <br />_ —he Bod,i Art has been described or shown to me and is correctly placed or drawn to my specifications. <br />_ I understand that tattooing is permanent and that if I choose to have it removed, it may be expersive and leave <br />cars. <br />_ I am the Gerson or the legal ID presented as proof that I am at least 18 years of age; and in the case of a <br />minor ece ving legal piercing, I am the legal parent or guardian of the minor receiving the legal piercing and I am <br />c ranting PE rmissic in -or this minor to receive the legal body piercing. <br />_ I am not under the influence of alcohol or drugs and that I am voluntarily submitting to Body Art work without <br />c uresE or coercior. . <br />_ Inks we ase are rct FDA approved and health consequences are still unknown. <br />_ I uncerstand the -e is a possibility of an allergic reaction. <br />_ I uncerstand the -e is a possibility of getting an infection. <br />_ I agree to follow all instructions concerning the care of my Body Art work, and that any touch-ups or repairs <br />that may become needed due to my own negligence will be done at my own expense. <br />_ I understand that tl-ere is a chance I might feel lightheaded or dizzy during or after Body Art work. <br />_ I agree to immedia$ely notify the artist in the event I feel lightheaded, dizzy and/or faint before, during or after <br />& e procedL re. <br />I, have been fully informed of the risks of Body Art including, <br />But, not limrted to i-ifectior, scarrirg, difficulties in detecting melanoma, and allergic reactions to pigments, latex <br />&%✓es, and antibiMc3. Having been informed of the potential risks associated with obtaining Body Art, I sti I wish <br />tc proceed wvith the Body Art work and I assume any and all risks that may arise from the Body Art work. If while <br />in facili-y, If faint or get hurt v✓e are not responsible for you or guest. <br />Signed <br />TATTOO PLACEMENT AND DESCRIPTION <br />Date <br />