10740 SW 24 St Miami - Florida 33165 | Cr 14 # 80-71 Zona Rosa - Bogotá
786 775 1287 | (57) 601 4553693

MEDICAL DISCLOSURE

Therefore in consideration of Goa Exotic Tattoo & Piercing allowing me to be tattooed/pierced at its studio by one of its tattoo artists or piercing professionals, and said tattoo artist or piercing professional actually applying a tattoo or performing a piercing procedure upon me, I hereby CONSENT to the tattooing or piercing procedure of my choice, and I forever RELEASE and discharge Goa Exotic Tattoo & Piercing, its officers, directors, employees, agents, executors, heirs, artists, and piercers, and all other persons, corporations, or entities, from any and all liability, claims, demands, damages, actions, causes of actions or suits ot any kinds or nature on account of any injuries of any type or kind, both known and unknown to my person or property which may result from being tattooed/pierced, entering the property being leased by Goa Exotic Tattoo & Piercing, or arising trom or connected in any way with the procedures, equipment, ink, dyes, pigments or conduct used in connection with the application of my tattoo/piercing or the Artist’S attistic interpretation of the tattoo design/piercing or location and placement of the design/piercing upon my body, quality of workmanship, spelling or meaning of words, name(s), symbols, color scheme used, shading, or size of tattoo/design/piercing/ jewelry. I also give Goa Exotic Tattoo & Piercing, its agents, employees, and representatives, permission to copyright and publish any photograph of myself. with or without using my name in any such manner deemed proper to their use. I realize that misinterpretation, or falsification of information provided by me is a crime subject to prosecution. I further certify that I am an adult overthe age of 18 and I am not intoxicated or under the influence of any narcotic substance, and make this statement by free will and sound mind. I also agree that I will follow the procedures outlined for the proper care and healing of my tattoo/piercing. This is a legal binding contract. You are also authorizing GOA Exotic Tattoo and Piercing Company to publicize photographic pictures and/or video of the procedure and/or the result of said procedure, if need be.