Treatment Consent & Indemnity Form

BY SIGNING THIS DOCUMENT YOU GIVE UP THE RIGHT TO SUE, AND ASSUME BOTH RISK AND EXTRAORDINARY RISKS INHERENT TO THE SMP Tattoo, 3D Areola Tattoo, 3D Belly Button Tattoo, Inkless Stretchmark Revision TO: GEC REALTY PTY LTD doing business as Hair Ink SMP Gold Coast/Areola Ink.

This Release and Waiver of Liability (the “Release”) releases “GEC REALTY PTY LTD.” doing business as “Hair Ink SMP Gold Coast/Areola Ink”, a corporation organized and existing under the laws of Australia and each of its directors, principals, officers, employees, and agents. In consideration of receiving a the “SMP Tattoo”, “3D Areola Tattoo”, “3D Belly Button Tattoo”, “Inkless StretchMark Revision”,) from any tattoo artist at Hair Ink SMP Gold coast/Areola Ink together with its employees, apprentices and/or agents (the “Artists”), the Client AGREES to the following:

1) I have been fully informed of the inherent risks associated with getting the SMP Tattoo, 3D Areola Tattoo, 3D Belly Button, Inkless Stretchmark Revision. I have been given full opportunity to ask any and all questions about the application of the SMP Tattoo, 3D Areola Tattoo, 3D Belly Button Tattoo, Inkless Stretchmark Revision and all of my questions have been answered to my total satisfaction. I fully understand that these risks, both known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, needles, gloves, and/or soap. Having been informed of the potential risks associated with getting the SMP Tattoo, 3D Areola Tattoo, 3D Belly button tattoo, Inkless Stretchmark Revision. I still wish to proceed with application of the SMP Tattoo, 3D Areola Tatto, 3D Belly Button Tattoo, Inkless Stretchmark Revision and I freely accept and expressly assume any and all risks that may arise from the procedure.

2) Hair Ink SMP Gold Coast/Areola Ink has given me instructions on the care of the SMP Tattoo, 3D Areola Ink, 3D Belly Button Tattoo, Inkless Stretchmark Revision, while it is healing, and I understand them and will follow them. I acknowledge that it is possible that the SMPTattoo, 3D Areola Tattoo, 3D Belly Button Tattoo, Inkless Stretchmark Revision may fade, particularly if I do not follow the instructions given to me. If any touch-up work to the SMPTattoo, 3D Areola tattoo, 3D Belly Button Tattoo, Inkless Stretchmark Revision is needed due to my own negligence, I agree that said work will be done at my own additional expense.

3) I acknowledge that over time, the pigment and the clarity of the completed SMP Tattoo, 3D Areola Tattoo, 3D Belly Button Tattoo will fade due to unprotected exposure to the sun and the natural occurring dispersion of pigment under the skin.

4) I understand that the SMP Tattoo, 3D Areola Tattoo, 3D Belly Button Tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before receiving the SMP Tattoo, 3D Areola tattoo, 3D Belly Button Tattoo.

5) I am not under the influence of alcohol or drugs, and I am voluntarily and willingly submitting myself to be tattooed by the Artists appointed to me without duress or coercion.

6) I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. I do not have any other medical or skin conditions that may interfere with the application or healing of the SMP Tattoo, 3D Areola tattoo, 3D Belly Button Tattoo, Inkless Stretchmark Revision. I am not the recipient of an organ or bone marrow transplant. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgement in getting the SMP Tattoo, 3D Areola Tattoo, 3D Belly Button Tattoo, Inkless Stretchmark Revision

7) I agree to WAIVE and RELEASE to the fullest extent permitted by law each of the Artists and Hair Ink SMP Gold Coast/Areola Ink from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from application of the SMP Tattoo,3D Areola Tattoo, 3D Belly Button Tattoo, Inkless Stretchmark Revision whether caused by the negligence or fault of either the Artists, Hair Ink SMP Gold Coast/Areola Ink, or otherwise.

8) I understand and acknowledge that this Release discharges the Artists and Hair Ink SMP Gold Coast/Areola Ink from any liability or claim that I may have against the Artists or Hair Ink SMP Gold Coast/Areola Ink with regard to bodily injury, personal injury, illness, death or property damage that may result from the SMP Tattoo, 3D Areola, Tattoo 3D Belly Button Tattoo, Inkless Stretchmark Revision.

9) I release all rights to any photographs taken of me and during the course of receiving the SMP Tattoo, 3D Areola Tattoo, 3D Belly Button Tattoo and I give consent in advance to reproduction of the photographs in print, digital, video or electronic form.

10) I further covenant and agree that from the date of execution of this Release I will neither directly or indirectly, either verbally or in writing, make any comments of a negative or disparaging nature whatsoever about any of the Artists or Hair Ink SMP Gold Coast/Areola Ink.

11) I agree to reimburse each of the Artists and Hair Ink SMP Gold Coast/Areola Ink for any attorneys' fees and costs incurred by any legal action I bring against either the Artists or Hair Ink SMP Gold Coast/Areola Ink and in which either the Artists or Hair Ink SMP Gold Coast/Areola Ink is the prevailing party.

12) I acknowledge that I have been given adequate opportunity to read and understand the Release, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artists and/or the Hair Ink SMP Gold Coast/Areola Ink. If any provision, section, subsection, clause or phrase of the Release is found to be unenforceable or invalid, that portion shall be severed from the Release. The remainder of the Release will then be construed as though the unenforceable portion had never been contained in the Release. I hereby declare that I am of legal age (and have provided valid proof of age) and am competent to sign the Release.

I, the Client named herein, acknowledge that I have read and fully understood the Release and accept the risks of receiving the SMP Tattoo.