I am not pregnant or nursing. I do not have epilepsy, diabetes, or hemophilia. I do not suffer from any heart conditions or take medications that thin the blood.

If I suffer from Hepatitis or any other communicable disease, I have informed the tattoo artist of this fact and have been advised of any medications or procedures necessary to promote satisfactory healing of my tattoo.

I do not suffer from medical or skin conditions such as, but not limited to: Keloid or hypertrophy scarring, psoriasis at the site of the tattoo or anyb open wounds or lesions at the site of the tattoo.

I have advised the Tattoo Artist of any allergies to metals, latex, soaps and medications. I acknowledge it is not possible for the tattoo artist to determine whether i might have an allergic reaction to the tattoo or process involved in the tattooing and further acknowledge that such a reaction is possible

I have truthfully represented to the Tattoo Artist that i am over the age of 18 years. I am not under the influence of any drugs or alcohol. To my knowledge, I do not have any physical, mental, or medical impairment or disability, which might affectmy judgement, and/ or my well being as a direct, or indirect result of my decision to have a tattoo done at this time.

I acknowlege that obtaining this tattoo is my choice and will result in a permanent change to my appearance, and that no representation has been made to me as to the ability to later restore the skin involved in this tattooing to the pre-tattooed condition.

I acknowlege infection is always possible as a result of obtaining a tattoo, and I agree to follow all instructions concerning the care of my tattoo while it is healing.

I certify that I know all needles used for my tattoo are single use, pre-packaged - pre-sterilized. I understand I am able to check all materials used for my tattoo before the tattoo has started. I understand that I am able to have information about the tattoo materials explained to me.

I understand that before my tattoo has started that all my questions have been answered and I am comfortable with the tattoo design, artist, and tattoo establishment.

I authorize to be tattooed. I understand this type of tattooing usually takes 2 weeks or longer to heal. I agree to release and forever discharge and hold harmless the Tattoo Artist and all employees at Sonder TPA, LLC from any and all claims, damages, or legal actions arising from or connected in any way with my tattooing, or the procedure and conduct used in the tattooing process.

By signing this release, I swear under penalty of perjury that i am atleast 18 years old and understand that i am receiving a tattoo from a licensed Tattoo Artist in accordance with all state laws, rules and regulations.