Your signiture is required at the end of this form after reading it in its entirety to show that you understand each provision.

In consideration of receiving a tattoo from Shealea Scharn, I agree to all of the following:

signify that I have been fully informed inherent risks associated with getting a tattoo. Therefore, I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the detection of melanoma and allergic reactions to tattoo pigment, latex gloves and/or soap. Having been informed of the potential risks associated with getting a tattoo I wish to proceed with the tattoo procedure and application and freely accept and expressly assume any and all risks that may arise from tattooing.

I waive and release to the fullest extent permitted by law Shealea Scharn from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of Shealea Scharn, or otherwise.

I acknowledge that it is not reasonably possible to determine whether I might have an allergic reaction to any of the pigments, topical preparations ,or products used in the procedure; and I agree to accept the risks that such a reaction, although rare, are possible.

I understand there are possibilities of unexpected side effects such (eyeliner) eye cornea abrasion and/or pigment migration.

It has been explained to me that immediately after the procedure(s) is completed, the color and the design will appear warm and bold. It has also been explained to me that within a short period of time (usually 7 days) the color will lighten/soften and the design/ procedure will heal thinner than it looked the day it was performed.

I acknowledge that hyper-pigmentation (darkening of the skin) or hypo-pigmentation (absence of color in the skin), or scarring is a possibility as a result of my body's reaction to the procedure. I realize that my body is unique and it is not possible to predict how my body will react as a result of this procedure.

I acknowledge that the procedure(s) will result in a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove the results.

I understand that future laser treatments, plastic surgery, implants, injections, and other skin altering procedures may alter and degrade my cosmetic tattoo procedure(s). I further understand that such changes are NOT the responsibility of Shealea Scharn and such changes in my appearance may NOT be correctable through further cosmetic tattoo procedures.

I understand that if I get an MRI (Magnetic Response Imaging) they will ask me if I have been tattooed.

I understand that tattooing is an art form and NOT an exact science, and I acknowledge that and that NO guarantees have been made to me as to the result of this procedure. My skin type and how well I take care of my procedure(s) will determine my result. I realize that my body and my skin is unique and difficult to predict how my skin may react to the procedure or how it may or may not accept color. I also realize that my artist cannot predict how many visits it will take to complete my procedure.

I accept full responsibility for approving the color, shape and position of the pigments that will be applied after my consultation. I understand the actual healed color of the pigment applied will be modified slightly due to my own unique skin undertones. I understand there is no guaranteed final shape or color for my tattoo.

Shealea Scharn has the right to refuse service for any reason.

This contract is to remain in effect for as long as I remain a client of Shealea Scharn. All its contents apply whenever work is being performed on myself. It is my responsibility to inform Shealea Scharn if any changes have occurred in my medical history.

Shealea Scharn has given me the full opportunity to ask any questions about the procedure and application of my tattoo and all of my questions, if any, have been answered to my total satisfaction.

Shealea Scharn has given me instructions on the care of my tattoo while it's healing. I understand and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.

I am NOT under the influence of drugs or alcohol, and am voluntarily submitting to be tattooed by Shealea Scharn without duress or coercion.

I do not suffer from diabetes, epilepsy, hemophilia, or heart condition(s), nor do I take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure, application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo.

Shealea Scharn is not responsible for the meaning or spelling of the symbol or text that I have provided or chosen from the flash (design) sheets. Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.

I understand that a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed.

I release the rights of any photographs or videos taken of me and consent in advance to their reproduction in print or electronic form.

I agree that Shealea Scharn has a NO REFUND policy on tattoos and/or retail sales and I will not ask for a refund for any reason whatsoever.

I agree to reimburse Shealea Scharn for any attorney's fees and costs incurred in any legal action I bring against Shealea Scharn. I agree that the courts located in Oregon shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.

I acknowledge that I have been given adequate opportunity to read and understand this document and that it was not presented to me at the last minute.

I grasp that I am signing a legal contract waiving certain rights to recover damages against Shealea Scharn. If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.

I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.