Beyond Bronze Mobile Tanning, LLC
Client Registration and Waiver Form
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email Address
*
Date of Birth:
*
-
Month
-
Day
Year
Date
If you are under the age of 18, please have your parents fill out this form and put their name and contact info below:
Who can we thank for referring you?
Please indicate any current or pre-existing medical conditions, check all that apply:
Pregnant
Nursing
Acne
Psoriasis/Eczema
Allergies
Fainting
Have you ever had a spray tan before?
No, this is my first time!
Once or twice!
So many times I can't count, I'm an expert!
Only by a booth, not by hand.
PHOTO RELEASE - Type YES or NO*I hereby grant permission to Beyond Bronze Mobile Tanning, LLC, to use photographs and/or video of me taken while wearing my "spray tan", to use in social media publications for Beyond Bronze Mobile Tanning, LLC advertising purposes only. This includes and is limited only to pictures I voluntarily give Beyond Bronze Mobile Tanning, LLC and/or pictures that I post publically on Social Media.
*
Please sign your name below, acknowledging the following: I hereby release and agree to hold Beyond Bronze Mobile Tanning, LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of Beyond Bronze Mobile Tanning, LLC, or that may otherwise arise in any way in connection with any services received from Beyond Bronze Mobile Tanning, LLC. I understand that this release discharges Beyond Bronze Mobile Tanning, LLC from any liability or claim that I, my heirs, or any personal representatives may have against Beyond Bronze Mobile Tanning, LLC, with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Beyond Bronze Mobile Tanning, LLC. This liability waiver and release extends to the san together with all owners, partners, and employees.
*
Submit
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