PHOTO & VIDEO CONSENT RELEASE FORM:
Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to BEAUTYINK BY LEANNE, LEANNE WONG, and/or BEAUTYINK BY KAYLA, its affiliates and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to
a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice;
b) Permission to use my name; and
c) Permission to use quotes from the interview(s) (or excerpts of such quotes), film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness.
This consent is given in perpetuity, and does not require prior approval by me.
CONSENT FORM:
I hereby authorize BEAUTYINK BY LEANNE, LEANNE WONG, and/or BEAUTYINK BY KAYLA to perform upon myself procedure listed above. I understand that with any treatment certain risks are involved and that complications or side effects from known or unknown causes could occur, including but not limited to: slight discomfort, allergic reactions, infections, slight bleeding and bruising, scarring, inconsistent color, spreading, fanning and fading of pigments. If any unforeseen condition arises in the course of the procedure, I further request and authorize my practitioner to use her full judgement and do whatever she deems advisable and necessary under the circumstances.
I accept full responsibility if anything goes wrong with the treatment, as well as determining and accepting the color(s) and position of the tattooing as agreed with my technician during the course of my consultation.
I understand that if I have any skin treatment, laser hair removal, plastic surgery or other skin altering procedures, it will result in an adverse reaction to my treatment today and will take full responsibility. I acknowledge some of these potential adverse changes may not be correctable.
I understand 100% success results cannot be guaranteed, and multiple sessions may be required to achieve optimal results. I am aware that the result of the procedure is determined by the following: age, medication, skin characteristics (i.e. dry/oily/sun-damaged), skin undertones, smoking, alcohol intake, sun exposure, general stress, a compromised immune system, poor diet, post procedure care treatment, and the use of chemicals such as retinal and glycolic acid.
I have received the pre- and post- procedure instructions, and I will strictly adhere to such instructions. I understand failures to do so may jeopardize my chances of a successful procedure.
I agree to follow all pre- and post- procedure instructions as provided and explained to me by the practitioner. I understand that infection and possible scarring can occur if I do not adhere to the said instructions.
To my knowledge, I do not have any physical, mental, medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have the procedure done at this time.
I hereby agree to waive and release, to the fullest extent permitted by law, BEAUTYINK BY LEANNE, LEANNE WONG, and/or BEAUTYINK BY KAYLA from all liabilities, whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors, or representatives may have for personal injury or otherwise - including direct and/or consequential damages - which result or arise from the procedure(s) I’ve listed above, whether caused due to negligence or fault of BEAUTYINK BY LEANNE, LEANNE WONG, and/or BEAUTYINK BY KAYLA.
I agree to reimburse BEAUTYINK BY LEANNE, LEANNE WONG, and/or BEAUTYINK BY KAYLA for any attorneys’ fees and costs incurred in any legal action I bring against BEAUTYINK BY LEANNE, LEANNE WONG, and/or BEAUTYINK BY KAYLA.
I am at least 18 years old.
I am not under the influence of drugs or alcohol.
I have received post-procedure instructions and will strictly adhere to such instructions. I understand that my failure to do so will jeopardize my chances for a successful procedure.
I acknowledge by signing below, I have given the full opportunity to ask any and all questions about the paramedical tattooing procedure(s), its process, and risks. The decision to have the paramedical tattooing procedure(s) preformed is my own and I understand and accept all risks involved, therefore releasing BEAUTYINK BY LEANNE, LEANNE WONG, and/or BEAUTYINK BY KAYLA from any liabilities. I CERTIFY THAT I HAVE READ, FULLY UNDERSTAND, AND AGREE TO THE CONDITIONS OF ALL ABOVE FORMS. I HAVE ALSO ANSWERED ALL QUESTIONS TO THE BEST OF MY KNOWLEDGE, AND ATTEST TO REQUESTING THE PROCEDURE(S) DONE AT MY OWN FREE WILL. I understand that there will be no issued refund after today's procedure.