Tattoo Consent Release Form

I acknowledge by signing this release form that I have been given the full opportunity to ask any and all questions I might have about obtaining a tattoo from Elmira Studio. I acknowledge that all my questions have been answered to my full and total satisfaction. I speci cally acknowledge that I have been advised of the facts and matters set forth below, and I agree as follows:

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I am not under the influence of alcohol or drugs.
I do not have acne, freckles, moles, sunburn, or have ever had a herpes infection in the area to be tattooed that might be agitated by the tattoo process (healing excluded).
I have looked over my design, checked the spelling if applicable, and give my full consent to the application of my tattoo.
I acknowledqe that I am not preqnant.
I acknowledge that I am free of communicable disease.
I acknowledge that I have truthfully represented, with ID, to the tattoo artist, associates, agents and representatives of Elmira Studio that I am over eighteen (18) years of age.
I acknowledge it is not reasonably possible for the tattoo artist, associates, agents and representatives of Elmira Studio to determine whether I might have an allergic reaction to the dyes, pigments, or processes used in my tattoo and I agree to accept that such risks are possible.
I acknowledge that I am aware 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 acknowledge that infection is always possible as a result of obtaining a tattoo particularly in that event that I do not take proper care of my tattoo.
I acknowledge receipt of written instructions advising me of proper care of my tattoo and recoQnize the absolute necessity of followinq those written instructions.
I acknowledge that variations in color and design may exist between any tattoos as selected by me and as ultimately applied to my body.
I acknowledge that tattooing is a permanent change to my appearance and that no representations have been made to me as to the ability to later change, alter or remove my tattoo.
I acknowledge that the obtaining of my tattoo is my choice alone and I consent to the application of the tattoo and to any actions or conduct of the associates, agents or representatives of Elmira Studio that are reasonable necessary to perform the tattoo procedure.
I agree to release and forever discharge and forever hold harmless and its tattoo artist, associates, agents o cers and shareholders from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo or the procedures and conduct used to apply my tattoo and any and all tattoos applied by Elmira Studio and its tattoo artist, associates, agents and representatives in the future.

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have been fully informed of the risks of tattooing including but not limited to infection, scarring, difficulties in detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, and antibiotics. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with tattoo application and I assume any and all risks that may arise from tattooing.

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