TATTOO AFTERCARE CONSENT FORM

PLEASE INITIAL IN THE BOXES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION. FEEL FREE TO ASK ANY QUESTIONS REGARDING THIS WAIVER.

- I have been informed of the inherent risks associated with having a recently applied tattoo wrapped in the Saniderm Tattoo Aftercare Bandage (“Product”). Therefore, I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the detection of melanoma and allergic reactions to tattoo pigment, latex gloves and/or soap. Having been informed of the potential risks associated with applying aftercare products to a tattoo including an adhesive bandage, I wish to proceed with the aftercare bandage application and freely accept and expressly assume any and all risks that may arise from having my tattoo wrapped with the Product.

- I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Company from all liability whatsoever, including but not limited to, 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 the procedure and application of the Product, whether caused by the negligence or fault of either the Company, or otherwise.

- The Company has given me the full opportunity to ask any questions about the aftercare procedure and all of my questions, if any, have been answered to my total satisfaction.

- I acknowledge that the Company cannot guarantee that the tattoo will be free of infection, even if I follow the aftercare instructions I receive.

- I do not have any medical or skin conditions that may interfere with the procedure, application or healing of the tattoo. I am not allergic to adhesives.

- I release the right to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form.

- I agree to reimburse the Company for any attorneys' fees and costs incurred in any legal action I may bring against the Company and in which the Company is the prevailing party. I agree that the courts of located in the County of Salt Lake within the State of Utah shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.

- I acknowledge that I have been given adequate opportunity to read and understand this document that it was not presented to me at the last minute and grasp that I am signing a legal contract waiving certain rights to recover damages against the Company.

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this agreement. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.