I am at least 18 years old. To my knowledge, I don’t have any physical, mental, or medical impairment or disability, which might affect my well being as a direct or indirect result of my decision to have any tattoo-related work done at this time. I agree to follow all instructions concerning the care of my tattoo while it is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense. I understand that if my skin colour is dark, the colours will not appear as bright as they do on light skin. Being of sound mind and body, hereby release any and all persons representing the technician/salon PRODUCTS from all responsibility. I accept any and all responsibility myself for any consequences that might stem from my decision to have any tattoo-related work done by the technician/salon I agree not to sue in connection with any and all damages, claims, demands, rights, and causes of action of whatever kind or nature, based upon injuries or property damage to, or death of myself or any other persons arising from my decision to have tattoo-related work done at this time, whether or not caused by any negligence of the technician/salon PRODUCTS. I agree for myself, my heirs, assigns, and legal representatives to hold harmless from all damages, actions, causes of action, claim judgments, costs of litigation, attorney’s fees, and all other costs and expenses which might arise from my decision to have any tattoo-related work done by Sarah May Tibbals the technician/salon. I agree to pay for any and all damages and injuries to any and all persons and property belonging to the technician/salon or any other person to whom the technician/salon may become liable contractually or by operation of law, caused by, or resulting from my decision to have any tattoo-related work done by the technician/salon I agree to leave the premises of the technician/salon or any other establishment where is engaged in business, promptly upon request, for any reason whatsoever, by any agent or employee of the technician/salon. I agree that these waivers also pertain to and are designed to protect any and all establishments where the technician/salon conducts business. I represent and warrant to the technician/salon that the following information is true and correct. I have read and understood each of the above paragraphs. Representation/Risk It has been explained to me that the procedure to be used is referred to as Micro-pigmentation/Semi permanent make-up or Intradermally Implantation. The process of implanting micro-deposits of pigment into the dermal layer of the skin. Micro-Pigment Implantation is a form of tattooing used for the purpose of permanent cosmetic makeup and skin imperfection camouflage. It has been explained to me that the practice of this procedure is not an exact science. Colours may not match perfectly or appear exactly as expected. Over the months and years following the procedure, softening, fading or change of colour of the pigment may occur. I understand touch-ups are available at additional cost. I understand that there is a possibility of hyper-pigmentation resulting from a procedure, especially individuals prone to hyper-pigmentation from a scar or other injury. I realize the procedure will probably result in permanent and irreversible colour change in die skin area treated. However rare, some of the possible complications resulting from this is procedure may include infection, scarring, swelling, bruising, numbness, and post procedure discomfort, allergic reaction to one of the pigments or aesthetic agents /numbing creams (topical or oral).I understand that the description of the procedure is not meant to scare me or alarm me. It is simply an effort to make me better informed so that I may give or withhold my consent for this procedure. Release of Liability I hereby authorize the technician/salon to take full-face photographs of the work performed both before and after treatment, and I further authorize the use of said photographs to be used for marketing purposes. I have informed the technician/salon that I am in good health and not under the care of any physician. I agreed to waive my right to a patch test prior to my application of cosmetic tattooing & I agree to release Sarah May Tibbals, the technician/salon and pigment manufactures from any and all liability related to allergic reactions. List of Conditions I understand that no warranty or guarantees have been made to me as to the results of this procedure. I have been told that there may be risks and hazards related to me performance of the procedure planned for me. I have been told that this procedure will most likely involve some pain and discomfort. I have been told that the markings are permanent and there is a risk of infection following the procedure. I have been told that there is a chance of allergic reaction to pigment and that my body may reject the pigment. I have been given an opportunity to ask questions about the procedure and the procedure to be used and the risks and hazards involved and I believe that I have sufficient information to give this informed consent. I understand that if I have an infection, adverse reaction or allergic reaction to the procedure. I must notify salon. I have received a copy of the Pre/Post Procedure Instructions. The instructions have been fully explained to me and I have read them or they have been read to me. I understand the instructions. I certify this form has been fully explained to me and I have read it or it has been read to me and I understand the contents.