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CONSENT TO APPLICATION OF TATTOO RELEASE AND WAIVER OF ALL CLAIMS

I acknowledge by signing this writing 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 Tomato Tattoo, inc. and that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth below, and I agree as follows:

PLEASE INITIAL EACH ITEM:
_______ I acknowledge that I am not pregnant.
_______ I acknowledge that I am free of communicable diseases.
_______ I acknowledge that I have truthfully represented to the employees, Agents and representatives of Tomato Tattoo, inc. that I am over 21 years old.
_______ I acknowledge that it is not reasonably possible for the representatives and employees of Tomato Tattoo inc. 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 risk is possible.
_______ I acknowledge that infection is always possible as a result of the obtaining of a tattoo , particularly in the event that I do not take proper care of my tattoo.
_______ I acknowledge receipt 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 representation 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 or conduct of the employees of Tomato Tattoo, inc. reasonably necessary to perform the tattoo procedure.
_______ I agree to release and forever discharge and hold harmless Tomato Tattoo corporation and its agents, employees, officers, and shareholders from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo or procedures and conduct used to apply my tattoo.
_______ I hereby give Tomato Tattoo, inc. consent to publish any and all photos of my tattoo.

Name______________________________
Address____________________________
Phone______________________________
Date of Birth________________________
Tattoo______________________________
Date_______________________________

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