Release Waiver Form: Ensure Safety and Protect Yourself with Opallotus

Consent Form

Opal Lotus Tattoo Consent Form

RELEASE AND WAIVER OF LIABILITY AND ASSUMPTION OF RISK (“Agreement”)

The following unsworn declaration is made in lieu of a sworn affidavit in accordance with §132.001 of the Texas Civil Practice & Remedies Code:

The following unsworn declaration is made in lieu of a sworn affidavit in accordance with §132.001 of the Texas Civil Practice & Remedies Code: “I, hereby give consent to (“Artist”) of Opal Lotus, LLC to perform a tattoo and/or piercing on me (or Minor, if applicable), and in consideration of doing so, I hereby release Artist and Opal Lotus, LLC from all manner of liabilities, claims, actions, and demands in law, or in equity, which I or my heirs might now or hereafter by reason of complying with my request of a tattoo.

Write Full Name

Select a Tattoo Artist

I acknowledge by signing this agreement (“Agreement”) that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo and/or piercing and that all of my questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree and place my Initials as follows:

• I (or Minor, if applicable) am not pregnant or nursing.

• I (or Minor, if applicable) do not have a medical or skin conditions such as, but not limited to acne, scarring (Keloid), eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. I will advise Artist if I (or Minor, if applicable) have any type of infection or rash anywhere on my (or Minor’s, if applicable) body.

• I acknowledge it is not reasonably possible for the representatives and employees of Opal Lotus, LLC to determine whether I (or Minor, if applicable) might have an allergic reaction to the pigments or processes used in my (or Minor’s, if applicable) tattoo and/or piercing, and I agree to accept the risk that such a reaction is possible.

• I understand that a tattoo and/or piercing may take several weeks to heal properly.

• I realize that variation in color and design may exist between any tattoo as selected by me and as ultimately applied to my (or Minor’s, if applicable) body. I understand that if my (or Minor’s, if applicable) skin color is dark, the colors will not appear as bright as they do appear on light skin.

•I understand that if I (or Minor, if applicable) have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures it may result in adverse changes to my (or Minor’s, if applicable) tattoo.

• I understand that a tattoo is a permanent change to my (or Minor’s, if applicable) appearance and that no representation has been made to me as to the ability to later change or remove my (or Minor’s, if applicable) tattoo. To my knowledge, I (or Minor, if applicable) do not have a physical, mental or medical impairment or disability which might affect my (or Minor’s, if applicable) wellbeing as a direct or indirect result of my decision to have a tattoo.

• I understand that any employee of Opal Lotus, LLC, including but not limited to Artist, does not act in the capacity of a medical professional when performing a tattoo and/or piercing. The suggestions made by any employee or agent of Opal Lotus, LLC are not to be construed as or substituted for advice from a medical professional.

• I consent to the application of the tattoo and/or piercing and to any actions or conduct of the representatives and/or employees of Opal Lotus, LLC that are reasonably necessary to perform the tattoo and/or piercing procedure.

• I am able to read in English and I fully understand the contents of this document.

Write Initials to acknowledge

I acknowledge that I am over the age of eighteen (18) and that I have truthfully represented to Artist that the obtaining of a tattoo and/or piercing is my own choice.

Write Initials to acknowledge

I have presented evidence of my identity to Artist or any other Opal Lotus, LLC employee, agent, or representative.

Write Initials to acknowledge

I am not under the influence of alcohol, drugs, or otherwise impaired in any way.

Write Initials to acknowledge

I understand that I have the right to request that the Artists cease to perform or continue to perform the tattoo and/or piercing at any point in time during the process. I further understand that the fee agreed to for the procedure is earned in full when Artist punctures the skin of any body part as part of the requested service.

Write Initials to acknowledge

I understand that performing a tattoo and/or a piercing, by its own nature, require the puncturing of skin on the subject body part.

Write Initials to acknowledge

I understand that the process of performing of a tattoo and/or a piercing, by its own nature, may cause me (or Minor, if applicable) varying degrees of pain and/or discomfort.

Write Initials to acknowledge

I acknowledge that infection is always possible as a result of obtaining a tattoo or piercing, particularly in the event that I (or Minor, if applicable) do not take care of the tattoo. I have received aftercare instructions and I agree to follow them while my tattoo and/or piercing is healing. I agree that any touch-up work needed, due to my own (or Minor’s, if applicable) negligence, will be done at my own expense.

Write Initials to acknowledge

I will advise Artist if I (or Minor, if applicable) have any condition that might affect the healing of the tattooed and/or pierced body part.

Write Initials to acknowledge

I HEREBY EXPRESSLY WAIVE AND RELEASE ANY AND ALL CLAIMS, now known or hereafter known, against Opal Lotus, LLC, and its officers, directors, manager(s), employees, agents, affiliates, shareholders/members, successors, and assigns (collectively “Releasees”), on account of injury, disability, or death arising out of or attributable to my participation in obtaining a tattoo and/or piercing at Opal Lotus, LLC, whether arising out of the ordinary negligence of Releasees or not. I covenant not to make or bring any such claim against Opal Lotus, LLC or any other Releasee(s), and forever release and discharge Opal Lotus, LLC and all other Releasees from liability under such claims. This waiver does not extend to claims for gross negligence, willful misconduct, or any other liabilities that are not permitted to be released by agreement under Texas law.

Write Initials to acknowledge

Opal Lotus, LLC and any other Releasee’s LIABILITY FOR ANY CLAIM NOT WAIVED OR RELEASED HEREIN OR BY LAW FOR LOSS, NON-PERFORMANCE, MONETARY DAMAGES OR BODILY INJURY TO ANY PART OF MY (or MINOR’s, IF APPLICABLE) BODY AND FOR ANY CLAIM ARISING OUT OF THIS AGREEMENT OR TORT IS THE FEE CHARGED AND PAID BY ME FOR THE PROCEDURE I SOUGHT OR REQUESTED TO ARTIST OR $100.00, WHICHEVER IS GREATER.

Write Initials to acknowledge

I hereby grant the artist and studio Opal Lotus the rights to use, for professional purposes, any images, videos, quotations, trademarks, logos or any other related media (collectively referred to as “media Content”) provided by myself or the artist or the studio. I grant the artist and studio unlimited, worldwide, non exclusive, royalty-free right and license to use, reproduce, dispute, publicly display and preform, modify and otherwise use any media content, in whole or in part, without further notice from artist and or studio. I agree to indemnify and hold the company harmless from any and all claims, liabilities, damages, costs and expenses (including legal fees and expenses) arising out of or related to media content.

Write Initials to acknowledge

If applicable, I am the parent or legal guardian of the minor named:

(“Minor”), Minor will be the subject of the tattoo and/or piercing procedure. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Release and Waiver of Liability and Assumption of Risk. I have presented evidence of my status as parent or guardian of Minor to Artist or any other Opal Lotus, LLC employee, agent, or representative.

My Date of Birth

My Full Street, City, and State Address Is:

Address Line 1

City

State

Zip Code

My Age Is

Executed in Harris County, State of Texas, on

LOCATION OF TATTOO ON BODY

Take Photo of ID/DL

Take Photo

COLOR(S) OF INK USED

AT THIS TIME PLEASE ASK ARTIST TO ENTER LOT NUMBER(S) OF INK USED IN TODAYS SESSION

Ink Lot #

Newsletter and Promotions Sign Up

Yes

Phone/Mobile

Signature

Sign Here

I hearby accept all terms on this contract with Opal Lotus Tattoo