Consent to Application of Tattoo, Release and Waiver of all Claims

I acknowledge by reading this document  that I understand the matters set forth below and I agree as follows:

• I acknowledge that I am not pregnant;

• I acknowledge that I have no history of diabetes, jaundice, hepatitis or similar diseases;

• I acknowledge that I truthfully represented to the employees, agents and representatives of Jennifer Moore  & SANCTUARY TATTOO that I am over the age of eighteen years;

• I acknowledge that some pre-existing medical conditions; such as allergies, diabetes, heart conditions, cancer, HIV+ status, etc., and some prescription medications, (antibiotics in particular) may adversely affect the healing of a tattoo as well as a person’s general health. I understand that if I have any concerns about this, that Jennifer Moore and SANCTUARY TATTOO strongly suggests I consult with a qualified health professional.

• I acknowledge that there is the possibility of an allergic reaction to the dyes, pigment or processes used in the tattoo, and that I agree to accept the risk that such a reaction is possible;

• I acknowledge that I DO/DO NOT (circle one) have a latex allergy;

• 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 acknowledge reading of written instructions advising me of the proper care of my tattoo, and I recognize the absolute necessity for following those instructions;

• 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 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;

• I acknowledge that the obtaining of my tattoo is by my choice alone and I consent to the application of the tattoo and to any actions of conduct of the employees, agents and representatives of SANCTUARY TATTOO reasonably necessary to perform the tattoo procedures;

• I acknowledge that all scheduled appointments with Jennifer Moore at SANCTUARY TATTOO require a minimum NON-REFUNDABLE deposit of $100 of larger work, or multiple sittings;

• I acknowledge that notice of cancelation is required at least 48 hours prior to all scheduled appointments at SANCTUARY TATTOO, or I forfeit my entire deposit;

• I acknowledge that deposits will be considered valid for a period of no more than 1 year from the date of a canceled appointment with 48 hour notice;

• I hereby give SANCTUARY TATTOO and its assigns, licenses, employees, agents and legal representatives the irrevocable right to use my name (or any fictional name), picture, portrait, or  photograph in all forms and media and in all manners, including composite or distorted representations, for promotion, advertising, display, trade or any other lawful purposes, and I waive any right to inspect or approve the finished product including written copy that may be created in connection therewith;

• I agree to release and forever hold harmless SANCTUARY TATTOO and its employees, agents and representatives, officers and shareholders from any and all claims, damages, or legal actions arising from or connected to in any way with my tattoo or the procedures and conduct used to apply my tattoo.Consent to Application of Tattoo, Release and Waiver of all Claims