I specifically acknowledge that:
1. Obtaining this tattoo is my choice alone and will result a permanent change to my appearance, and that no representation has been made to me as to the ability to later restore the skin involved in this tattoo to its pre-tattoo conditions.
2. It is not reasonably possible for the tattoo artist to determine whether I have an allergic reaction to the tattoo or process in the tattoo and further acknowledge that such a reaction is possible.
3. Intenze and starbrite colors are distributed by Dermagraphics Mfg & Supply INC. The ingredients of these dispersions are represented to be non-toxic by the manufacture; however no representation is made regarding their use as an approved tattoo ink.
4. I will be tattooed using appropriate instruments and sterilization techniques
5. I have been advised of all the procedures necessary to promote satisfactory healing of my tattoo
6. I must consult a health care provider for: unexpected redness, tenderness, swelling , unexpected drainage at the site of the piercing, any rash or a fever within (2) hours of the body art procedure
7. Infection is always a possible result of obtaining a tattoo, and I agree to follow all the instructions concerning the care of my tattoo while it is healing. However, if infection will occurs as a result of this tattoo, I release and discharge the business Back Stage, its owners and employees, and the tattoo artist, from all liability.
I represent to my tattoo artist that
* I am not pregnant or nursing
* I do not have epilepsy or hemophilia.
* I do not have HIV, Hepatitis or any other communicable disease.
* I do not have heart conditions or take any medications that thin my blood
* I do not have any medical or skin conditions such as, but not limited to, Keloids, Hypertrophy scarring, Psoriasis, Lesions or open wounds at the site of the tattoo
* I am at least 18 years of age