Spray Tanning Consent Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth

Date

Gender

Were you referred by an individual? If yes, please indicate in the field.

Where did you learn about our Tanning Salon?

Is this your first spray tanning?

If no, then please indicate when did you last perform spray tanning?

E.g. two months ago, a year ago, or exact date

What is your skin type?

Do you have allergies? If yes, please indicate them in the field.

Do you suffer from any skin conditions? If yes, please indicate them in the field.

Are you allergic to Dihydroxyacetone (DHA)?

Are you pregnant or breastfeeding? (Female only)

Are you currently taking any medications?

I hereby give consent and grant permission for Golden Shimmer Spray Tan to use specified photographs and/or vidoes taken before, during and after the treatment/procedure I have requested today. I understand that my identity will be protected and neither my full face, nor my name will be used in conjunction with the photographs and/or video.

I hereby waive any right to inspect or approve the finished photographs and/or vidoe and agree that they may be used by Golden Shimmer Spray Tan in their marketing, social media, advertising any printed and digital media on their website.

Additionally, I waive my right to payment, royalties or any other compensation that may arise from the use of these photographs and/or video.

I confirm that I am at least 18 years of age and by signing this form, I acknowledge that I have completely read and understood the above release and agree to be bound thereby.

---------------------------------------------------------------------------------------------

The information I have provided regarding my Medical History is accurate to the best of my knowledge. I understand the information given pertaining to Spray Tanning and confirm that I do not have any condition/s that would make this treatment unsuitable.

I understand that I am taking sole responsibility for any reaction that I may have to the tanning solution, staining to my clothing, and/or personal belongings. I am using these services at my own risk.

I agree to waive all liability towards my Technician and Golden Shimmer Spray Tan for any injury or damages incurred due to my failure to disclose any existing or past health conditions.

Parent/Guardian signature required below if under 18 years of age.

Client's Signature

Date Signed

Date

Spray Tanning Consent Form

Photo/Video Release Form and Consent Form