I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo from Speak In Silence Art Co Tattoo Studio and that all of my 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:
1. I have truthfully represented to Speak In Silence Art Co Tattoo Studio that I am over eighteen (18) years of age.
2. I acknowledge that it is not reasonably possible for the representatives and employees of Speak In Silence Art Co Tatoo 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 the risk that such a reaction is possible. I acknowledge 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.
3. I acknowledge that I have advised my tattoo artist of any condition that might affect the healing of this tattoo. I do not have medical or skin conditions such as but not limited to: acne, scaring (keloid), eczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise the tattooer.
4. I am not pregnant or nursing.
5. I am not under the influence of alcohol or drugs.
6. I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense. This includes sun and ultraviolet frequency damage.
7. l acknowledge that a tattoo 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. To my knowledge, I do not have 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.
8. I acknowledge that if my tattoo is a symbol, or something written in a language other than English, the tattoo artist and the owner of this business are not responsible for what it may or may not mean.
9. I acknowledge that if my tattoo includes text that I am responsible for the correct spelling, grammar and punctuation. I have proofed the text before it is applied as a tattoo.
10. I acknowledge the decision for obtaining my tattoo is my own free will and choice. I consent to the location of the tattoo and the performance of the tattoo procedure.
11. I acknowledge that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.
12. I acknowledge and agree to following any and all instructions provided to me regarding the maintenance of a sanitary environment while I am being tattooed.
13. I agree that the tattoo design is correctly drawn to my specifications and I agree to allow for artist interpretation of the image.
14. I agree to IMMEDIATELY notify the artist if I feel lightheaded, dizzy and/or faint before, during or after the procedure, Failure to do so releases Speak nI Silence Art Co Tattoo Studio and my tattoo artist of all responsibility.
15. I do not have a history of herpes at the proposed procedure site, diabetes, allergic reactions to latex or antibiotics, hemophilia or other bleeding disorders, or cardiac valve disease. If I do have any of these conditions I will advise my tattooer.
16. I do not have a history of medication use nor am I currently taking my medications, including prescribed antibiotics prior to dental or surgical procedures. If I am taking any medications I agree to advise my tattooer.
17. I hearby grant Speak In Silence Art Company permission to use my photograph(s) or electronic media images to be used on the internet, or in any other print or electronic medium. I will make no monetary or other claim against Speak In Silence Art Company for use of the photographs.