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ry 2 Monkeys Tattoo = Consent & Waiver =READ AND CHECK THE BOXES WHEN YOU ARE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING (FILL OUT BOTH SIDES.OF FORM) I being eighteen(18)years of age or older,hereby consent to a tattoo to be conducted by"12 Monkeys Tittoos"or an agent or employee of the same as follows: Tattoo description: Location on body: Artist: -P rice: I understand"12 Monkeys Tattoos"has taken appropriate steps to ensure sanitary conditions for said tattoo. More specifically,I have initialed the areas below indicating: Only single use sterile needles are used,and are disposed of in a medical sharps container after every tattoo. The pigments and supplies that will be used in the application of the tattoo are single use per customer. i have received and read the aftercare information,and understand-the steps necessary for safe,sanitary maintenance. 1 acknowledge by signing this agreement that i have beengiven the full opportunity to ask any and all questions which I might have about obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. i specifically acknowledge I have been advised of the facts and matters sez forth below and I agree;'and-have initialed the areas as follows: I am not under the influence of drugs.or alcohol. To my knowledge I do not have any physical,mental or medical impairments or disability which might affect my wellbeing as a direct or indirect result of my decision to have a tattoo done at this time. V I understand that there is a chance I might feel lightheaded,dizzy or faint during or after being tattooed and agree to immediately notify the practitioner in the event I feel lightheaded,dizzy and/or faint before,during or after the procedure. I acknowledge that obtaining a tattoo is my choice alone and will result in a change to my appearance,and that no representation has been made to me as to the ability to later restore the skin involved in this tattoo to its pre-tattooed condition. I understand that tattooing is permanent and that if I choose to have it removed,it may be expensive and leave scars. I acknowledge it is not reasonably possible for the representatives and employees of this tattoo shop to determine whether 1 might have an allergic reaction to the pigments or processes used in my tattoo,and I agreeto accept the risk that such a reaction is possible I acknowledge that infection is always possible as-a result of the obtaining of a tattoo,particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is,healing. I agree that any touch-up work needed,due to my own negligence,will be done at my own expense. I realize that variations in_color and design may exist between any tattoo as selected by me andlor the artist and is ultimately applied to my body. I understand that if my skin color is dark,the colors will not appear as bright as they do on light skin. I, 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,and 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. i agree to pay the above price in full at the time services are rendered. In consideration for the tattoo services performed at my request,I release"12 Monkeys Tattoos"and any of its employees,agents,contractors,or assigns thereof,from all claims and rights of actions of any kind which I now have or which may accrue,arising out of the abovedescribed tattoo services and related activities,including but not limited to: claims of personal injury,property damage and other losses incurred as a result(direct or indirect)of said tattoo services,including injuries, damages and losses which are presently known as well as those which may develop or be discovered in the future. I further waive all of said claims and rights of action. I have read this document and understand the procedure and any potential risks thereof and agree to all of its contents. I represent that all information provided by me on this form and verbally is true and accurate. NAME: DATE OF BIRTH ADDRESS: PHONE( ___ ) DRIVERS LICENSE# STATE EMAIL: (if you wish to receive upcoming event information) CUSTOMER/CLIENTS SIGNATURE ARTIST SIGNATURE DATE: DATE: a —