I ACKNOWLEDGE I AM NOT UNDER THE INFLUENCE OF DRUGS OR ALCOHOL THAT COULD IMPAIR MY

JUDGMENT! TO MY KNOWLEDGE, I DO NOT 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 ANYBODY PIERCING AT THIS TIME. I UNDERSTAND THAT THE POSSIBILITY OF INFECTION MAY EXIST DUE TO IMPROPER HYGIENE OR CARE ON MY PART, FOR WHICH I WILL NOT HOLD THIS FACILITY RESPONSIBLE FOR NOT FOLLOWING THEIR SPECIFIED INSTRUCTIONS, WHICH HAS OR WILL BE EXPLAINED TO ME. BEING OF SOUND MIND AND BODY, I HEREBY RELEASE ANY AND ALL PERSONS REPRESENTING THIS FACILITY FROM ALL RESPONSIBILITY FOR MYSELF AND FOR ANY CONSEQUENCE THAT MAY STEM FROM MY DECISION TO HAVE BODY PIERCING DONE BY THIS FACILITY

I STATE THAT ALL OF THE INFORMATION THAT I HAVE FURNISHED TO SCREAMING INK TATTOO IS TRUE

I Received verbal and written instructions that I should follow to promote healing of the pierced area.