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I,______________________________________________, D.O.B._______________________ have contracted with FALLING ANGEL TATTOO on the date below to tattoo the following part(s) of my body: ______________________________________________. I understand that there are certain risks associated with having the above part of my body tattooed I assume sole responsibility of those risks, and that should an infection devolope that medical attention may be necessary. I understand & agree to follow the recommended after care given to me by the artist. I agree not to hold FALLING ANGEL TATTOO &/or its employees, or any promoter or person(s) who provide space to FALLING ANGEL TATTOOS liable in any manner for any problems arising from having the above procedure performed. I state that I am over the age of 18 and that I am not under the influence of any drugs &/or alcohol, and that I have informed FALLING ANGEL TATTOOS of any medical conditions that I may have: Prescription Medication:______________________________, Heart Condition:____________________________________, Diabetes:__________________________________________, Allergies to:________________________________________, Communicable Diseases:______________________________, Other:_____________________________________________
Signature:_____________________________________Date:____/____/____
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