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a� r <br /> � d <br /> CMMFWM <br /> 4N, <br /> DATE DO <br /> CITY <br /> COUNTRY <br /> WORK PH <br /> id <br /> RMU <br /> u IRED_ COST OF PROCEDUREA: <br /> acknowledge by signing this agreement that I have been given the full <br /> d all questions which I might have.about the obtaining of a tattoo and that all of my <br /> Y to my full satisfaction. I specifically acknowledge 1 have beerf advised of the <br /> forthtam been answered <br /> maVas set below and I agree as follows: <br /> jj_ if I have any condition that might affect the healing of this tattoo,,I will advise my tattooer. I am not pregnant or <br /> I am not under the Influence of alcohol or drugs. <br /> I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid), eczema, psoriasis, <br /> freckles,molee or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of <br /> Infection or rash anywhere on my body, I will advise my tattooer. <br /> I acknowledge It is not reasonably possible for the representatives and employees of this tattoo shop to <br /> determine whether i might have an allergic reaction to the pigments or p <br /> 'pocesses used in my tattoo,and I agree <br /> to accept the risk that such a reaction is possible. <br /> I acknowwge that infection Jr.always possible as a result of the obtaining of a tattoo,particularly in the event <br /> tug I do not take proper care of my tattoo. I have received aft® re in ctions and I agree to follow them <br /> while my tattoo is healing. I agree that any touch-up work needed, due t6 my own negligence, will be done at <br /> my own expense. <br /> •I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately <br /> applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on <br /> 1W skin. <br /> I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering <br /> procedures, it may result in adverse changes to my tattoo. <br /> * I acknowledge that a tattoo, also known as body art, is a permanent change to my appearance and that no <br /> representations have been made to me as to the ability to later change or remove my tattoo.To my knowledge, <br /> I do not have a physical, mental or medical impairment or disability which might affect my well <br /> beim as a direct or indirect result of my decision to have a tattoo. <br />