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I agree to release and forever discharge, and hold harmless, the Technician, all employees, contractors, m anagement, and facility of the permanent make-up studio from any and all claims of negligence, damages, or legal actions arising from or connected in any way with my tattoo, procedure, and conduct used in my tattoo and assume all responsibility for the decision(s) made consenting to this permanent procedure. I am aware that permanent cosmetic inks, dyes, and pigments have not been approved by the federal Food and Drug Administration and that the health consequences of using these products are unknown. I acNnowiedge infection is always possible as a result of permanent make-up application. I have received pre -a -id pest -procedure instructions and I understand them and will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. I agree that it is my responsibility to contact my Technician if there are any signs and symptoms of infection, including, but not Vnited to redness, swelling, tenderness of the procedure site, red streaks going from the procedure site towards the heart, elevated body temperature, or purulent drainage from the procedure site. I understand that the taking of before and after photographs of the said procedure are a condition of such procedure. I alease all rights to any photographs taken of me and the permanent make-up and give consent in advance to this permanent make-up studio to use images of my tattoo(s) for marketing and/or publishing purposes in various media such as the intemet, magazine, printed, and/or television etc. I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adv--rse changes may not be correctable. I am not Dregnant or nursing. I do not have any history of herpes infection at the proposed procedure site. i do not have epilepsy, diabetes, allergic reaction to latex or antibiotics, hemophilia or other bleeding disorders. I do no- have cardiac valve disease or suffer from any heart conditions or take medications that thins my blood If I suffie- from hepatitis, or other risk factors for bloodborne pathogen exposure, or any other communicable disease; I have informed the Technician of the fact and have been advised of any medications and procedure3 ne,:essary to promote the satisfactory healing of my tattoo. I do not Suffer from any medical or skin condition(s) such as, but not limited to: keloid or hypertrophic scarring, psoriasis at the site of the permanent make-up, or any open wounds or lesions at the site of the tattoo. I do not ,ave a history of medication use or currently using medication, including being prescribed antibiotics prior to zental or surgical procedures. If I am on any medication for depression or any other mood - altering prescription, I will advise my Technician. I agree t, reimburse each of the Technician and the Body Art Facility for any attorney fees and costs incurred in any legal action I bring against either the Technician or the Body Art Facility and in which either the Technician or the Body Art Facility is the prevailing party. I agree that the courts of California State,in San U S C F t'_y li! .L Pri' I� ED I Cl1 i it} NS