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THIS DOCUMENT IS TWO- PAGES. PLEASE INITIAL IN THE BOXES PROVIDED AFTER <br />READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION, FEEL FREE TO ASK ANY <br />QUESTIONS REGARDING THIS WAIVER. <br />In consideration of receiving a tattoo from Cactus Flower Tattoo Studio including its artists, associates, <br />apprentices, agents, or any employees (hereinafter referred to as the "Tattoo Studio" I agree to the <br />following: <br />- I, .(Print Name) have been fully informed of <br />the inherent risks associated with getting a tattoo. Therefore, I fully understand that these risks, known <br />and unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the <br />detection of melanoma and allergic reactions to tattoo pigment, latex gloves and/or soap. Having been <br />informed of the potential risks associated with getting a tattoo I wish to proceed with the tattoo <br />procedure and application and freely accept and expressly assume any and all risks that may arise from <br />tattooing. <br />- I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Tattoo <br />Studio from all liability whatsoever, including but not limited to, any and all claims or causes of action <br />that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any <br />direct and/or consequential damages, which result or arise from the procedure and application of my <br />tattoo, whether caused by the negligence or fault of either the Tattoo Studio, or otherwise. <br />-The Tattoo Studio has given me the full opportunity to ask any question about the procedure <br />and application of my tattoo and all of my questions, if any, have been answered to my total <br />satisfaction. <br />-The Tattoo Studio has given me instructions on the care of my tattoo while it's healing. I <br />understand and will follow them. I acknowledge that it is possible that the tattoo can become infected, <br />particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed <br />due to my own negligence, l agree that the work will be done at my own expense. <br />- I am not under the influence of alcohol or drugs, and I am voluntarily <br />submitting to be <br />tattooed by the Tattoo Studio without duress or coercion. <br />- I do not suffer from diabetes,. epilepsy, hemophilia, heart conditi <br />on(s), nor do I take blood <br />thinning medicaflon. I do not have any other medical or skin condition that may interfere with the <br />procedure, application or healing of the tattoo. I am not the recipient of an organ or bone marrow <br />transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics that is required by <br />my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or <br />nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo. <br />-The Tattoo Studio is not responsible for the meaning or spell <br />Page 1 <br />ing of the <br />symbol or text that I <br />have provide <br />to them or chosen from the flash <br />(design) sheets. <br />Page 1 <br />