CONSENT TO TATTOO APPLICATION RELEASE AND WAIVER OF ALL CLAIMS I acknowledge by signing this release that I have been given the full opportunity to ask any and all question which I might have about obtaining a tattoo procedure from previously specified technician (hereafter called "Technician") and that all of my questions have been answered to my full and total satisfaction. Procedure to be performed: Permanent Tattoo or Permanent Makeup. I specifically acknowledge that I

have been advised of the matters set forth below and agree as follows:

I acknowledge that obtaining a permanent tattoo and/or permanent makeup procedure is my choice alone and the application said procedure will result in a permanent change to my appearance and that needles and inks will go into my skin. No representations have been made to me as to the ability to later restore the skin involved in a tattoo procedure to the original condition, and it is very costly to remove.

I am not pregnant or nursing. I do not have any history of herpes infection at the proposed procedure site. I no not have epilepsy, diabetes, allergic reaction to latex or antibiotics, hemophilia or other bleeding disorder. I do not have cardiac valve disease or suffer from any heart conditions or take medications that thins my blood. If any of the above pertain to you, please explain:

If I suffer from hepatitis or other risk factors for blood borne pathogen exposure, or any other communicable disease, I have informed the Technician of the fact and have been advised of any medication and procedure necessary to promote the satisfactory healing of my tattoo. I acknowledge that obtaining a permanent tattoo and/or permanent makeup procedure is my choice alone and the application said procedure will result in a permanent change to my appearance and that needles and inks will go into my skin. No representations have been made to me as to the ability to later restore the skin involved in a tattoo procedure to the original condition, and it is very costly to remove., I am not pregnant or nursing. I do not have any history of herpes infection at the proposed procedure site. I no not have epilepsy, diabetes, allergic reaction to latex or antibiotics, hemophilia or other bleeding disorder. I do not have cardiac valve disease or suffer from any heart conditions or take medications that thins my blood. If any of the above pertain to you, please explain:, If I suffer from hepatitis or other risk factors for blood borne pathogen exposure, or any other communicable disease, I have informed the Technician of the fact and have been advised of any medication and procedure necessary 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 procedure area, or any open wounds or lesions at the site of the procedural area., I do not have a history of medication use or currently using medication, including being prescribed antibiotics prior to dental or surgical procedures., I have advised the Technician of any allergies to latex gloves, soaps, or medications. I acknowledge it is not reasonably possible for the Technician to determine whether I might have allergic reaction to the tattoo process and further acknowledge that such reaction is possible., I have truthfully represented to the Technician that I am 18 years of age or older. I am not under the influence of any drugs or alcohol. To my knowledge, I do not have any physical, mental or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have a tattoo or permanent makeup procedure done at this time., I acknowledge infection is always possible as a result of a tattoo procedure application and I agree to follow all suggested instructions concerning the care of the tattoo procedure site while it is healing., I acknowledge and give consent to this tattoo studio to use images of my tattoo(s) for marketing and or publishing purposes in various media such as the internet, magazine, printed and/or television etc., I understand I will have a tattoo procedure applied using appropriate instruments and sterilization techniques. I understand that the tattoo procedure site usually takes 2 weeks or longer to heal. I agree to release and forever discharge, and hold harmless the Technician, all employees, contractors and the management of the tattoo procedure studio from any and all claims of negligence, damages, or legal actions arising from or connected in any way with my tattoo, the procedure, and conduct used in my tattoo and assume all responsibility for the decision(s) made consenting to this permanent procedure., I am away that tattoo 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 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 procedure area, or any open wounds or lesions at the site of the procedural area.

I do not have a history of medication use or currently using medication, including being prescribed antibiotics prior to dental or surgical procedures. I acknowledge that obtaining a permanent tattoo and/or permanent makeup procedure is my choice alone and the application said procedure will result in a permanent change to my appearance and that needles and inks will go into my skin. No representations have been made to me as to the ability to later restore the skin involved in a tattoo procedure to the original condition, and it is very costly to remove., I am not pregnant or nursing. I do not have any history of herpes infection at the proposed procedure site. I no not have epilepsy, diabetes, allergic reaction to latex or antibiotics, hemophilia or other bleeding disorder. I do not have cardiac valve disease or suffer from any heart conditions or take medications that thins my blood. If any of the above pertain to you, please explain:, If I suffer from hepatitis or other risk factors for blood borne pathogen exposure, or any other communicable disease, I have informed the Technician of the fact and have been advised of any medication and procedure necessary 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 procedure area, or any open wounds or lesions at the site of the procedural area., I do not have a history of medication use or currently using medication, including being prescribed antibiotics prior to dental or surgical procedures., I have advised the Technician of any allergies to latex gloves, soaps, or medications. I acknowledge it is not reasonably possible for the Technician to determine whether I might have allergic reaction to the tattoo process and further acknowledge that such reaction is possible., I have truthfully represented to the Technician that I am 18 years of age or older. I am not under the influence of any drugs or alcohol. To my knowledge, I do not have any physical, mental or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have a tattoo or permanent makeup procedure done at this time., I acknowledge infection is always possible as a result of a tattoo procedure application and I agree to follow all suggested instructions concerning the care of the tattoo procedure site while it is healing., I acknowledge and give consent to this tattoo studio to use images of my tattoo(s) for marketing and or publishing purposes in various media such as the internet, magazine, printed and/or television etc., I understand I will have a tattoo procedure applied using appropriate instruments and sterilization techniques. I understand that the tattoo procedure site usually takes 2 weeks or longer to heal. I agree to release and forever discharge, and hold harmless the Technician, all employees, contractors and the management of the tattoo procedure studio from any and all claims of negligence, damages, or legal actions arising from or connected in any way with my tattoo, the procedure, and conduct used in my tattoo and assume all responsibility for the decision(s) made consenting to this permanent procedure., I am away that tattoo 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 have advised the Technician of any allergies to latex gloves, soaps, or medications. I acknowledge it is not reasonably possible for the Technician to determine whether I might have allergic reaction to the tattoo process and further acknowledge that such reaction is possible.

I have truthfully represented to the Technician that I am 18 years of age or older. I am not under the influence of any drugs or alcohol. To my knowledge, I do not have any physical, mental or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have a tattoo or permanent makeup procedure done at this time.

I acknowledge infection is always possible as a result of a tattoo procedure application and I agree to follow all suggested instructions concerning the care of the tattoo procedure site while it is healing.

I acknowledge and give consent to this tattoo studio to use images of my tattoo(s) for marketing and or publishing purposes in various media such as the internet, magazine, printed and/or television etc.

I understand I will have a tattoo procedure applied using appropriate instruments and sterilization techniques. I understand that the tattoo procedure site usually takes 2 weeks or longer to heal. I agree to release and forever discharge, and hold harmless the Technician, all employees, contractors and the management of the tattoo procedure studio from any and all claims of negligence, damages, or legal actions arising from or connected in any way with my tattoo, the procedure, and conduct used in my tattoo and assume all responsibility for the decision(s) made consenting to this permanent procedure.

I am away that tattoo 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.

By signing and submitting this agreement, I (1) acknowledge that I have read and fully understand the terms of the agreement; (2) voluntarily agree to be bound by this agreement; and (3) certify that I am 18 years of age or older. My signature applies to all pages of this contract,.