If I have anemia, diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease, heart condition or take medicine which thins the blood I have advised my piercer. I am not pregnant or nursing. I am not under the influence of alcohol or drugs
I do not have medical or skin conditions such as, but not limited to acne, scarring(keloid), eczema, psoriasis, freckles, moles or sunburn in the area to be pierced that may interfere with said piercing
I acknowledge it is not reasonably possible for the representative and employees of SILVERPOINT TATTOO COMPANY CORP. to determine whether I might have an allergic reaction to the metals or processes used in my piercing, and I agree to accept the risk that such a reaction is possible
I acknowledge that infection is always possible as a result of obtaining a piercing, particularly in the event that I do not take proper care of my piercing. I have received aftercare instructions and I agree to follow them while my piercing is healing.
I realize that variations in piercing and design may exist between any tattoo as selected by me and as ultimately applied to my body
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my piercing
To my knowledge, I do not have any physical, mental, medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a piercing
I acknowledge I am over the age of sixteen (16) and that I have truthfully represented to my piercer that the obtaining of a piercing is by my choice alone. I consent to the application of the piercing and to any actions or conduct of the representatives and employees of SILVERPOINT TATTOO COMPANY CORP. reasonably necessary to perform the piercing procedure
I WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist(s) and SILVERPOINT TATTOO COMPANY CORP. from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the application of my piercing, whether caused by the negligence or fault of either the piercer or SILVERPOINT TATTOO COMPANY CORP., or otherwise