CONSENT FOR TATTOO APPLICATION, RELEASE AND WAIVER OF ALL CLAIMS

I acknowledge, by submitting this waiver, that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo from ALYSSA MOORE.

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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 below and I agree as follows.

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I acknowledge all of the following:

 - I acknowledge that I have looked over my stencil thoroughly and have approved it

 - I acknowledge that I am not pregnant

 - I acknowledge that I am free of communicable diseases

 - I acknowledge that it is not reasonably possible for ALYSSA MOORE to determine whether I might have an allergic reaction to dyes, pigments, or processes used in my tattoo, and I assume such risk is possible

 - I acknowledge receipt of written instructions, via the AFTERCARE tab on inkbyamoore.ca, advising me of proper care of my tattoo and I recognize the absolute necessity of following those instructions

 - I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not follow proper after-care instructions

 - I acknowledge that variations in colour and design may exist between any tattoo as selected by me and ultimately applied to my body

 - I acknowledge that a tattoo is a PERMANENT change to my appearance and that no representation has been made to me as to the ability to later change or remove the tattoo

 - I acknowledge that obtaining my tattoo is my choice alone and I consent to the application of the tattoo and any actions or conduct reasonably necessary for ALYSSA MOORE to perform the tattoo procedure

 - I agree to release and forever discharge and hold harmless ALYSSA MOORE from any and all claims, damages, or legal actions arising or connected in any way with my tattoo or procedures and conduct used to apply my tattoo

 - I hereby give ALYSSA MOORE consent to publish photos of myself and all photos my tattoo

 - I hereby acknowledge that a security camera is operating in the tattoo room and agree to its use for security purposes, while acknowledging the footage will not be used for publishing or posting on social media

 - I am not under the influence of drugs or alcohol

 - I have read and understand all rules, as listed on the SHOP page under SHOP RULES

 - I agree that the contact information I provide below may be used by Ink by A. Moore for the purposes of appointment confirmation

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I acknowledge that I have truthfully represented myself to ALYSSA MOORE, that I am at least 18 years of age and that I am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete concurrence with this agreement.

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I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.

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I am aware that it is illegal to give false information and I hereby declare that all of the information I have given is true and agree to all of the above information.