I acknowledge by signing this release that I have been given full opportunity to ask any and all questions which I might have about obtaining a tattoo/piercing and that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the matters set forth below and agree as follows:

I am not pregnant or nursing. I do not have epilepsy, diabetes, or hemophilia. I do not suffer from any heart conditions or take medications that thin the blood.

If I suffer from Hepatitis or any other communicable disease, I have informed the Body Artist of this fact and have been advised of any medications or procedures necessary to promote satisfactory healing of my tattoo.

I do not suffer from medical or skin conditions such as, but not limited to: Keloid or hypertrophy scarring, psoriasis at the site of the tattoo or any open wounds or lesions at the site of the tattoo/piercing.

I have advised the Body Artist of any allergies to metals, latex, soaps, and medications. I acknowledge it is not possible for the Body Artist to determine whether I might have an allergic reaction to the tattoo/piercing, pigment, dyes, disinfectants or process involved and further acknowledge that such a reaction is possible. List the allergies conditions: _____________________________________________________

I have truthfully represented to the Body Artist that I am over the age of 18 years (or have my parent or legal guardian present). 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, which might affect my judgment, and/or my well being as a direct, or indirect result of my decision to have a tattoo/piercing done at this time.

I acknowledge that obtaining this tattoo/piercing is my choice and will result in 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/piercing to the previous condition.

I acknowledge infection is always possible as a result of obtaining a tattoo/piercing, and I agree to follow all instructions concerning the care of my tattoo/piercing while it is healing.

Therefore, I authorize the Body Artist to tattoo. I understand the healing process an I agree to release and forever discharge and hold harmless the Body Artist and all employees from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo/piercing, or the procedure and conduct used in my tattoo/piercing.

BY SIGNING THIS RELEASE, I SWEAR UNDER PENALTY OF PURJURY THAT I AM AT LEAST 18 YEARS OLD (OR HAVE MY PARENTS OR LEGAL GUARDIAN PRESENT). AND UNDERSTAND THAT I AM RECEIVING A TATTOO/PIERCING FROM A LICENSED BODY ARTIST IN ACCORDANCE WITH ALL STATE LAWS, RULES AND REGULATIONS.

Tattoo waiver software, a permanent security software.

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