Authorization and Consent Form

The undersigned hereby consents to (RP) taking photographs of the undersigned, both before and after procedures being undertaken by (RP) at the request of the undersigned. It is further understood, acknowledged, and herein authorized fir (RP) to use photographs for the purpose of (RP) compiling an album of its various clients for the purpose of showing prospective clients the procedures completed by (RP) in its normal course of business. In the event that undersigned shall expressly state by completing to (RP) Schedule “A” attached here to and the undersigned thereafter acknowledges and consent to (RP) retaining said photographs solely for its own files for its own use internally in the development and monitoring of all services provided. The undersigned further acknowledges that it has been advised by (RP) not to drive a motor vehicle or operate a machinery or equipment for a period of not less than eight hours after an eyeliner procedure and the undersigned further hereby saves harmless and indemnifies (RP) for any damages whatsoever resulting from the undersigned not complying with the request of (RP) as stated herein. The undersigned further accepts full responsibility for and indemnifies and holds Ronnie Padilla harmless and without liability of any kind whatsoever for the pigment coloration and position of all permanent make-up on its eyebrows, eyeliner and lips. Tweezing, waxing or electrolysis will have been performed or completed within one week prior to the commencement of the procedure herein consented to. The undersigned having read the above acknowledges that all of the procedure contemplated and consented to here in have being fully explained and the undersigned fully understands the nature, scope and repercussions of the procedure herein consented to being performed and the undersigned here in fully accepts responsibility for any and all results if the said procedure. The undersigned further also acknowledges that an information provided by the undersigned to (RP) is being provided for the purpose of (RP) own internal compilation of information and under no circumstances, is it deemed to be given for the purpose of Ronnie Padilla or any of its employees giving or making any medical decisions, opinion, diagnosis or representation to the undersigned or to any party whatsoever.The undersigned hereby consent (RP) to perform the treatment more specifically described as follows:

And the undersigned in consideration of Ronnie Padilla completing the above-described procedures hereby forever release and further agrees not to make any claim or demand or commence, maintain or prosecute any action cause or proceeding for damages, compensation, loss or any relief whatsoever against (RP) in respect of any cause, matter of thing whatsoever existing or relating to the procedures performed as described herein. The undersigned further agrees that this release shall operate conclusively as an estoppel in the event of any such claim, action or proceeding and may be pleaded accordingly. This release shall be deemed to have made in and shall be constructed in accordance with the Laws of the Province of Alberta. This release shall administrators, legal personal representatives, successors and assigns. In witness of whereof the undersigned has caused this release to execute on this date.

VISIT ONE Date (MM/DD/YYYY) __________________ SIGNATURE:

VISIT TWO Date (MM/DD/YYYY) ___________________ SIGNATURE: