RELEASE OF LIABILITY

I hereby release Black Penny Tattoo LLC or any person representing Black Penny Tattoo. FROM ANY LIABILITY, CLAIMS, ACTIONS OR DEMANDS RELATING TO ANY TATTOO WORK I RECEIVE AT “BLACK PENNY TATTOO”.

I UNDERSTAND THAT I WILL BE TATTOOED USING APPROPRIATE INSTRUMENTS ANDTECHNIQUES. TO ENSURE PROPER HEALING I AGREE TO THE FOLLOWING PROCEDURES OUTLINED ON THE TATTOO CARE SHEET FOR THE CARE OF MY TATTOO.

I UNDERSTAND THAT THIS TATTOO WILL USUALLY TAKE TWO WEEKS OR LONGER TO HEAL AND IS PERMANENT.

I ACKNOWLEDGE THAT I AM NOT PREGNANT OR NURSING. THIS FACILITY DOES NOT USE LATEX, BUT PLEASE NOTIFY US OF ANY KNOWN ALLERGIES.

I ACKNOWLEDGE THAT I AM NOT SUFFERING FROM DIABETES, HEMOPHILIA OROTHER BLEEDING DISORDERS, CARDIAC VALVE DISEASE, HIV, HERPES, ALLERGIES, AND/OR DISCOLORATION OF THE SKIN, SWELLING, LUMPS OR ANY SIGNS OF IRRITATION OF THE AREA TO BE TATTOOED AND / OR ANY OTHER CONDITIONS WHICH WOULD MAKE THIS PROCEDURE DANGEROUS. IF THERE IS A CHANCE OF INFECTION OR ALLERGIC REACTION SEE A DOCTOR/PHYSICIAN IMMEDIATELY.

I UNDERSIGNED, SO VERIFY THE PROPER IDENTIFICATION AND THAT I AM AT LEAST 18 YEARS OF AGE. I am not under the influence of alcohol or drugs and I acknowledge that this tattoo is permanent. If you are on any medication please let us know. Inks, dyes and pigments used in body art have not been approved by the FDA and health consequences are unknown at this time.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, BY COMPLETING THIS FORM I CONSENT TO THE ABOVE TERMS AND RISKS.