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

MaleFemale

If you are under 18 years of age, please type their name(s) here. By entering their names, you are acknowledging that you have permission from them to get a spray tan:

No, this is my first time!Once or twice!So many times I have lost count, I'm an expert!Only by a booth, not by hand!

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

YesNo

YesNoNot sure

YesNo

If you answered yes to taking medications, please list them here. We follow all HIPAA laws and will never share your information, however certain medications such as antibiotics and acne medications, can effect the outcome of your spray tan.

Please sign your name below, acknowledging the following:

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that our technicians put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that SunBlast Mobile Tanning, LLC can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, spray tan staff, and other spray tan clients and their families.

I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I attest that:

* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.

* I have not traveled internationally within the last 14 days.

* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.

* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.

* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

I hereby release and agree to hold SunBlast Mobile Tanning, LLC and all staff, 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 SunBlast Mobile Tanning, LLC, or that may otherwise arise in any way in connection with any services received from any technician affiliated with SunBlast Mobile Tanning, LLC.

I understand that this release discharges SunBlast Mobile Tanning, LLC and staff from any liability or claim that I, my heirs, or any personal representatives may have against SunBlast 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 SunBlast Mobile Tanning, LLC. This liability waiver and release extends to the san together with all owners, partners, and employees. *

Client's Signature

Date Signed

Date

PHOTO RELEASE - Write YES or NO*

I hereby grant permission to SunBlast Custom Airbrush Spray Tanning, LLC, to use photographs and/or video of me taken while wearing my "spray tan", to use in social media publications for SunBlast Mobile Tanning, LLC advertising purposes only. This includes and is limited only to pictures I voluntarily give SunBlast Custom Airbrush Spray Tanning, LLC and/or pictures that I post publically on Social Media.

Write YES or NO with your finger here:

Date Signed

Date

Spray Tanning Consent Form

Consent Agreement