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(Page 2) <br /> PERMANENT MAKEUP CONSENT FORINd <br /> (continued) <br /> The Technician performing the procedure will not be held liable for and damages caused to me <br /> or my skin by any reason, including allergic reaction, skin sensitivity, and failure to follow the after <br /> care instructions. <br /> __ I have declared all relevant history, and if any changes occur in the future I will notify my <br /> Technician. <br /> __I understand that this description of the procedure is not meant to scare or alarm me. <br /> It is simply an effort to make me better informed so that I may give or withhold my consent for this <br /> procedure. I consent to the permanent makeup procedure being performed on me and accept that I <br /> understand the risks and complications involved. <br /> CLIENT NAME (PRINTED): 64.M TNA�KA€;(SiQi 4&N;LWRE): DATE: <br />