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RECITALS <br /> • a. The Releasee wishes to have the permanent cosmetic procedure(s)performed by the Releasor. <br /> b. The Releasee has been informed by the Releasor that permanent cosmetics is the same as tattooing; <br /> therefore, the facial area will be cosmetically tattooed. Color will be implanted into the skin and as a <br /> result,the skin color will be permanently altered. <br /> c. The Releasee has been informed by the Releasor that there is pain involved in the procedure(s). <br /> d. The Releasee has been informed by the Releasor that there may be adverse side effects such as swelling, <br /> bruising(extremely rare),temporary minor bleeding,redness or pinkness, and soreness. <br /> e. The Releasee has been informed by the Releasor that the lips may feel dry and tight after a lip <br /> procedure. <br /> f, The Releasee has been informed by the Releasor that fever blisters or cold sores may occur after the <br /> permanent cosmetic lip procedure if the Releasee is prone to having them. The Releasee has been <br /> informed by the Releasor to obtain a prescription for Zovirax and take as prescribed for two weeks prior <br /> to the permanent cosmetic lip procedure that will be performed in order to help prevent this. <br /> g. The Releasee has been informed by the Releasor not to take any aspirin or Ibuprofen permanent <br /> cosmetic facial tattoo procedure as it may promote bleeding. Tylenol may be taken,however. <br /> h. The Releasee has been informed by the Releasor not to wear any contact lenses during the permanent <br /> cosmetic eyeliner procedure. An antihistamine may be taken in order to help prevent excessively watery <br /> eyes. <br /> i. The Releasee has been informed by the Releasor to wait one year after a tattoo procedure before <br /> donating blood. <br /> j. The Releasee has been informed by the Releasor to inform medical personnel or professional esthetician <br /> of your cosmetic facial tattoo if a chemical peel, MRI, or plastic surgery is to be performed near or over <br /> the cosmetic facial tattoo. <br /> k. The Releasee has been informed by the Releasor to use sunscreen on a daily basis because constant <br /> exposure of the cosmetic facial tattoo to the sun may fade the color. <br /> 1. The Releasee has been informed by the Releasor that any effective removal of the permanently <br /> implanted pigment may cause scarring. <br /> m. The Releasee has read and having been verbally told of all of the above recitals by the Releasor, the <br /> Releasee nevertheless desires to have the permanent cosmetic facial tattoo procedure(s) performed by <br /> the Releasor and is willing to enter into this agreement. <br /> I have read,been verbally told, and understand each of the above recitals. <br /> Signature Date <br /> Photographer's Model Release <br /> For a consideration mutually agreed upon, and received by me for posing for photographs hereto, I, the <br /> undersigned, do hereby assign to you the copyright and/or the right to copyright such photography and the right <br /> of reproduction thereof, either wholly or in part, and unrestricted use thereof in whatever manner you or your <br /> licenses or assignees may, in your or their absolute discretion, think fit for all or any advertising, medical <br /> teachings, or other purposes whatsoever, including the right of necessary retouching and tinting or workup for <br /> reproduction purposes. <br /> Customer Signature Date <br /> Witness Parent/Guardian <br />