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BODY <br /> 117 - . IS <br /> STRETCH MARK/SCAR CAMOUFLAGE TATTOOING <br /> F1All questions about the body art procedure have been answered to my satisfaction. <br /> I acknowledge that variations in color and design may exist between any cosmetic tattoos as selected by me and <br /> as ultimately applied to my body. <br /> I acknowledge that cosmetic tattooing is a permanent change to my appearance and that no representations have <br /> been made to me as to the ability to later change,alter or remove my tattoo. <br /> acknowledge that the obtaining of my cosmetic tattoo is my choice alone and I consent to the application of the <br /> tattoo and to any actions or conduct of the associates,agents or representatives of Body Regenesis I.I.C.that are <br /> reasonably necessary to perform the tattoo procedure. <br /> agree to release and forever discharge and forever hold harmless Body Regenesis I.I.C.and its associates,agents, <br /> officers and shareholders from any and all claims,damages,or legal actions arising from or connected in any way <br /> with my tattoo or the procedures,and conduct used to apply my tattoo and any and all tattoos applied by Body <br /> Regenesis LLC.and its associates,agents and representatives in the future. <br /> F-1 <br /> I agree to follow all instructions concerning the care of my cosmetic tattoo,and that any touch-ups needed because <br /> of my own negligence will be done at my own expense. <br /> AUTHORIZATION/CONSENT(required) <br /> Please type your name in full to indicate your agreement to this authorization for treatment. <br /> Today's date(required) <br /> Artist(required). <br /> Courtney Conley <br /> Needle lot#(required) <br /> 5 <br />