I acknowledge that all my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters setforth below, and I agree as follows:

1. I acknowledge that I have truthfully represented to the associates, agents and representatives of STEVIES that I am over eighteen (18) years of age.
2. I am not under the influence of alcohol or drugs.
3. I do not have acne, freckles, moles, or sunburn in the area to be tattooed that might be agitated by the tattoo process (healing excluded).
4. I have looked over my design, checked the spelling if applicable, and given my full consent to the application of my tattoo.
5. I acknowledge that I am not pregnant.
6. I acknowledge that I am free of communicable disease.
7. I acknowledge it is not reasonably possible for associates, agents and representatives of STEVIES to determine whether I might have an allergic reaction to dyes, pigments, or processes in my tatoo and I agree to accept that such risks are possible.
8. 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, and have been advised of the signs and symptoms of infection that indicate a need to seek medical care.
9. I acknowledge that variations in color and design may exist between any tattoos as selected by me and as ultimately applied to my body.
10. 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.
11. 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 STEVIES that are reasonable necessary to perform the tattoo procedure.
12. I agree to release and forever discharge and forever hold harmless STEVIES and it’s associates, agents officers and shareholders from any and all claims, damages, 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 STEVIES and it’s associates, agents and representatives in the future.
13. I acknowledge that tattoo inks, dyes and pigments have not been approved by the federal Food and Drug Administration and the health consequences of using these products are unknown.
14. I acknowledge that there is a change I might feel lightheaded, dizzy during or after being tattooed. I agree to immediately notify the practitioner in the event I feel lightheaded, dizzy and/or faint before, during or after the procedure.
15. I agree to follow all instructions concerning the care of my tattoo, and that any touch ups needed because of my own negligence will be done at my own expense.

By signing and submitting this form, I acknowledge that I have been given the opportunity to ask questions with regard to the risks of obtaining a tattoo which have been answered to me to my satisfaction. I acknowledge I am at least eighteen (18) years of age and I have no mental condition. I likewise have no physical condition that might affect my well-being as a result in having a tattoo on my skin. I give my full consent to the application for obtaining a tattoo without influence, coercion, or representation from any person.