Spark Project Collective Consent to Permanent Cosmetics Procedure

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:

Tattoo - A Mark on a person or a part of the body with an indelible design by inserting pigment into punctures in the skin.

Full Name*

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Home address:

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ID or Drivers License #*

Phone Number*

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Birth Date*

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Agree

I am NOT under the influence of drugs or alcohol. I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as the ability to later change or remove my tattoo. To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo.*

Agree

Client understands that there is a certain level of discomfort associated with the procedure and that each person has their own threshold level for discomfort. The technician may apply commercially available, topical anesthetics to alleviate the discomfort. The client is advised that it may be desirable to obtain additional, topical anesthetic from their physician if they have a low threshold for pain. This may cause injury to nerves and, although unlikely, the client may have an allergic reaction to the topical anesthetics.*

Agree

Client understands that adverse side effects from the procedure may include, but are not limited to, temporary minor bleeding, bruising of skin surfaces, swelling, redness or temporary discoloration of affected areas. Cold sore breakouts on lips may occur subsequent to the procedure for Clients with a prior history of cold sores. There is a risk of infection and/or scarring following the procedure.*

Agree

Client acknowledges that Technician has provided, as applicable, their recommendations related to color, shape, density, positioning and orientation of permanent makeup eyebrow, eyeliner, lip liner/full lip coloration and/or camouflage, and all other permanent cosmetics. However, the ultimate decision related to these parameters is the sole responsibility of the Client. The client holds harmless Technician and Spark Project Collective from any permanent makeup applications that do not meet the aesthetic desires of the Client. Permanent Cosmetics may require multiple applications to achieve the desired effect. Client understands, our policy for subsequent touchups and understands that such touchups may be necessary to achieve the desired results. Subsequent touch-ups may be necessary to achieve the desired results and will be charged accordingly. Client understands touchups are necessary and the next visit will cost a predetermined amount discussed with artist.*

Agree

Client acknowledges that Technician has provided, as applicable, their recommendations related to color, shape, density, positioning and orientation of permanent makeup eyebrow, eyeliner, lip liner/full lip coloration and/or camouflage. However,the ultimate decision related to these parameters is the sole responsibility of the Client. The client holds harmless Technician and Spark Project Collective from any services from any permanent makeup applications that do not meet the aesthetic desires of the Client.*

Agree

Client acknowledges that tech and Spark Project Collective does not guarantee the success of removals,correction or camouflage procedures due to a large number of variables that affect the success of such procedures. Client acknowledges counsel by Technician as to the probability of success of such procedures. Client agrees that technician and Spark Project Collective liability is limited to the cost of the procedure performed. In the event of disputes that cannot be amicably resolved, technician, Spark Project Collective and Client agree to binding arbitration to resolve any disputes at Clients expense. The client has been advised that if prone to cold sores (Herpes simplex virus), consideration should be given to taking Zovirax, as prescribed by a physician, or L-Lysine (an over-the-counter amino acid nutritional supplement) for several days prior to the procedure to reduce the occurrence of cold sores after the procedure. The client has been advised that the procedure may result in localized stress that can result in a cold sore breakout. Such a breakout, if it should occur, is a stress-induced result of the procedure and is not a result of improper sanitation techniques.*

Agree

If requested by client, technician can perform a patch test to ascertain potential allergic reaction to the implanted pigment. The technician has found that our pigments have a low probability of an allergic reaction, but cannot absolutely rule out the possibility of allergic reaction. The efficacy of a patch test has been discussed with the Client. It is clients responsibility to request a patch test. The client holds Technician and Spark Progect Collective harmless, and absolves Technician and Spark Project Collective from all liability resulting from allergic reactions to implanted pigments. Spark Project Collective only utilizes sterilized, disposable equipment to minimize the risk of infection or contamination. In addition, Technician has received training in appropriate sanitation and hygiene techniques prior to performing any procedures. While technician believes the risk of infection from our procedures is extremely small, the possibility of such an occurrence cannot be totally precluded. Accordingly, Client understands and accepts this risk and releases Spark Project Collective and technician from any and all liability related to the subject procedure, expecting instances involving gross negligence.*

Agree

I certify this form has been fully explained to me, that I have read it or it has been read to me. I understand its contents. As evidenced by my signature below, I understand and agree to the above conditions upon which Spark Project Collective and technician will be performed. I acknowledge that Spark Project Collective reserves the right to record the buildings 24 hours per day inside all rooms, public areas and its surrounding parking lot to protect the staff and possible loss of any equipment and property.*

Agree

Signature*

Consent for Permanent Cosmetics Procedure