Consent to Application of Tattoo & Release / Waiver of All Claims for:
John Joseph Maher IV, hereby referred to as Joe Pepper
I acknowledge by signing this document that I have been given full opportunity to ask any and all questions which I might have about the application of a tattoo by Joe Pepper, all of my questions have been answered to my full satisfaction. I specifically acknowledge that i have been advised of the facts and matters set forth below and agree as follows;
I acknowledge that it is not reasonably possible for Joe Pepper to determine whether I might have an allergic reaction to the dyes and pigments and processes used during my tattoo, and I accept to take this risk that such is a possible risk and to not hold Joe Pepper responsible for any allergic reaction should it occur. (Red Reaction being the most common). I DO NOT have a latex allergy.
I acknowledge that infection is always possible, particularly in the event that I do not take proper care of my tattoo during the healing process, and in no way do I hold Joe Pepper responsible for any problems or expenses that may occur should infection take place. I acknowledge Joe Pepper is using properly sterilized equipment and new one-time use pre-sterilized needles.
-
I realize that variations in color and design may exist between any tattoo selected by me and what is ultimately applied to my body.
-
I understand that a tattoo is permanent and that it can only be removed by surgical means; and that removal of such could leave scarring and disfigurement.
-
I have truthfully represented myself to Joe Pepper to be of 18 years of age or older.
-
I do not have a heart condition, epilepsy, nor am I a hemophiliac, that today or six months prior to today have NOT been infected with Hepatitis or HIV.
-
I am NOT pregnant.
-
I acknowledge that the obtaining of my tattoo is my choice alone and I do consent to the application of such. If my picture is taken I give permission for it to be used in any form of media for advertising, promotional or education purposes with no compensation to myself.
-
I acknowledge that I am not under the influence of drugs and or alcohol at the time the tattoo is applied.
I agree for myself, heirs, assigns and legal representatives to release and forever hold harmless Joe Pepper from any and all claims, damages or legal actions arising from or connected in any way with the tattoo or the procedures and conduct used to apply said tattoo, in any and all places Joe Pepper conducts business.
I have read and understood each of the above paragraphs.