Consent Application & Waiver of all Claims

l acknowledge by signing this agreement that l have been given the opportunity to ask any questions which I might have about the obtaining of the tattoo/piercing from “Beneath The Surface Tattoos” and that all my questions have been answered to my full and total satisfaction. I specifically acknowledge that l have been advised of the facts and matters set forth below and l agree as follows.

l acknowledge that a tattoo or piercing is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo and the removal can only be done by a surgical procedure that may leave permanent scarring or disfigurement. To my knowledge, I do not have any physical, mental or medical impairments or disabilities to which might affect my well-being as a direct or indirect result of my decision to have any tattoo or body piercing related work done at this time.

I acknowledge that infection/allergic reaction is always possible as a result of obtaining a tattoo/piercing, particularly in the event that I do not take proper care of my tattoo/piercing while it is healing. I understand that if there are issues that arise due to my tattoo/piercing I agree that any touch—up work needed due to my own negligence, will be at my own expense. I hereby release any and all persons representing Beneath The Surface Tattoos, or any other persons to whom Beneath The Surface Tattoos may become liable contractually or by operations of law, caused by, or resulting from my decision to have any tattoo/piercing work done by Beneath The Surface Tattoos.

I agree that these waivers also pertain to and are designed to protect all establishments where Beneath The Surface Tattoo conducts business. I have read and understand each of the above paragraphs. I represent and warrant Beneath The Surface Tattoos that the following information is true and correct. I acknowledge that l have received a copy of this form.