Deity Spray Tanning Release Form

Please read, understand and sign the following.

• Spray tanning is accomplished by application of a solution containing the active ingredient: DHA (Dihydroxyacetone). DHA is considered to be safe and has been FDA approved ONLY if you follow guildlines to protect mucous membranes. The FDA advises asking the following questions when
considering the application of DHA by spraying or misting:

· Are you protected from exposure in the entire area of the eyes, in addition to the eyes
themselves?
· Are you protected from exposure on the lips and all parts of the body covered by mucous
membrane?
· Are you protected from internal exposure caused by inhaling or ingesting the product?

If the answer to any of these questions is "no," you are not protected from the unapproved use of DHA. You should request measures to protect your eyes and mucous membranes and prevent inhalation.

• You will enter the area where you designate us to go where you will remove your clothing. This is up to you and your level of comfort. You should wear a dark swimsuit or underwear. Spa undergarments may be available upon request. The solution will wash out of most clothing. It is always best to wear dark loose fitting cotton clothing. Long sleeves and sweatpants are ideal. You want to keep the skin covered. No robes post tan.

•This process will take approximately ten to fifteen minutes. After spraying, your skin should be dry before putting your clothes back on and you should not bathe or sweat excessively for 6-8 hours. The solution will give you an immediate bronzing effect. The bronzing effect is a result of a coloring additive in the solution that will remain on the skin until you are actually tan. When you shower, the coloring will come off to reveal your actual tan beneath.

• All people are different. All ingredients used in this procedure are intended for cosmetic use and generally regarded as safe. There are, however, occasions where individuals may be allergic to one or more ingredients in the spray tan solution. Please read the ingredients list if you have any known allergies.

• Be advised there is a small percentage of people whose skin may not react favorably to spray tanning. For this reason, we do NOT advise being sprayed for the first time when your appearance is critical; (wedding/special occasion)

• Caution – Pregnant or nursing women should consult their physician before using.

• Warning – This product does not contain a sunscreen and does not protect against sunburn. Repeated exposure of unprotected skin to U.V. Light may increase the risk of skin aging, skin cancer and other harmful effects to the skin even if you do not burn. We are not able to spray tan over sunburned/peeling skin.

I have been provided with spray tan care instructions, which I have read and understand completely. To my knowledge, I have no medical condition or allergy which would preclude me from having this procedure done. I have been honest and accurate about the information that I have provided on this waiver. I take sole responsibility of any reaction.

I have read and completely understand this consent form.

Ingredients:

Overnight solution: Deionized Water, Aloe Barbadensis Leaf Extract, Dihydroxyacetone, Ethoxydiglycol, Cetearyl Isononanoate, Ceteareth-20, Cetearyl Alcohol, Glyceryl Stearate, Glycerin, Ceteareth-12, Cetyl Palmitate, Caramel, Walnut Extract, Polysorbate 20, Tocopherol Actetate(Vitamin E), Retinyl Palmitate(Vitamin A), Ascorbic Acid(Vitamin C)

Rapid solution: Deionized Water, Dihydroxyacetone, Cetearyl Isononanoate, Ceteareth-20, Cetearyl Alcohol, Glyceryl Stearate, Ceteareth-12, Glycerin, Cetyl Palmitate, Ethoxydiglycol, Caramel, Sorbitol, Polysorbate-20, DMDM Hydantoin, Ext Violet #2

If you have had sunburn or peeling skin in the past 2-3 weeks, we advise against getting a spray tan. Your skin needs time to heal. The spray tan will not adhere to the skin correctly at this time. Also keep in mind, we can not even out tan lines that are severely darker than your natural skin tone. Signing below you have read and understood these conditions. *

Full Name:*

First NameLast Name

Client Signature:*

Any known allergies or health issues we should be aware of? If you are pregnant must consult with doctor and receive ok prior. Doctors note of approval may be required for certain client’s health. Skin conditions or allergies may require patch test. People allergic to nuts MUST book a rapid. Our regular solution contains WALNUT EXTRACT. Ingredients are listed above if needed to send to Dr.*

Date*

Date

Date of Birth:*

Date

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Email*

example@example.com

Reason for being sprayed - if wedding specify

Instagram handle -

How did you hear about us? *

Any advice for parking for your appointment? Street, driveway, parking lot, etc. Clients in the city occur additional charges for street meter parking or parking garage. Please insert closest garage if known.

If you are in a building that has access codes, please provide below. If you have butterflymx, our cell is 267-608-5232 to send over the QR code.

If client is under the age of 18, parent/guardian signature required for services

Parent/Guardian Signature:

Signature - I have read and understood the instructions given above, and understand not following prep/care can result in a compromised tan. *

I understand cancelling my appointment within 24 hours prior to appointment time will result in a cancellation fee of 50% of booked service. - INITIAL BELOW*

Deity Spray Tanning Consent Form