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Int. 1. To my knowledge, I do not have any mental or medical impairment or disability <br />which might affect my well-being as a direct or indirect result of my decision to have any tattoo <br />and/or piercing procedure done at this time. <br />Int. 2. I agree to follow all instructions concerning the care of my tattoo and/or piercing <br />while it's healing. I agree that any touch up work, due to my negligence, will be done at my own <br />expense. <br />hit. 3. I understand that if my skin color is dark, the colors will not appear as bright as <br />they do on lighter skin. Additionally, I understand that the finished tattoo may vary somewhat in <br />appearance, color and/or design from the paper or other drawing or photographic image which the <br />tattoo design is based. <br />Int. 4. All questions about the procedure have been answered to my satisfaction, and I <br />have been given written aftercare instructions for the procedure I am about to receive. <br />Int. 5. I am the person on the I.D. presented as proof I am at least 18 years of age. <br />Int. 6. I have been advised that the tattoo will be permanent and that it can only be <br />removed with a surgical procedure, and that any effective removal will leave permanent scarring <br />and disfigurement. This cautionary notice is required to be provided to me by the health <br />department and I hereby acknowledge receipt of this formal notice. <br />Int. 7. I understand there is a risk of an allergic reaction and agree not to hold Colorful <br />Addictions responsible for any allergic reactions. <br />Int. 8. I am not under the influence of drugs or alcohol and that I am voluntarily <br />submitting to be tattooed without distress or coercion. <br />Int. 9. I understand tattoo inks are not FDA approved and health consequences are <br />unknown. <br />Int. 10. I swear or affirm and agree that the above information is true and correct. <br />I have been provided with information describing the tattoo and/or piercing <br />procedure to be preformed and instructions on after care. I understand it is my <br />responsibility to take care of my new tattoo and/or piercing site according to the <br />instructions provided both verbally and in writing. I have been fully informed of the risks <br />of tattooing including but not limited to infection, scarring, difficulties in detecting <br />melanoma, and allergic reaction to tattoo pigments, latex gloves and antibiotics. <br />Following the tattoo the tattoo area may be sore and have some redness. Also during <br />healing may experience some itching and peeling. If any indication of infection such as <br />fever, puss or extreme pain please seek medical attention. Having been informed of all <br />potential risks associated with getting a tattoo, I still wish to proceed with the tattoo <br />procedure and I assume any and all risks that may arise from tattooing. <br />[A.iff <br />[TiR--Ti <br />TattooInfonnation <br />Description of tattoo <br />wordS <br />Location on body <br />Price <br />Exact spelling of names or <br />