Coral & Coconut Spray Tanning Consent Form

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

Date

Gender*

MaleFemale

Parent or Guardian Consent (Required for Minors): I GIVE MY PERMISSION as parent or guardian of this minor for this sunless spray tan application. (Initial to provide consent).

Where did you learn about Coral & Coconut?*

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

Is this your first spray tanning?*

YesNo

If no, then please indicate when your most recent spray tan was.

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

What is your skin type?*

NormalDryOilySensitive

How does your skin react when exposed to sunlight?*

Always burns, never tansUsually burns, tans with difficultySometimes mild burn, gradually tansRarely burns, tans with easeVery rarely burns, tans very easilyNever burns, tans easily

What is your natural complexion?*

Fair or paleOlive or light brownBeige with golden undertonesDark brown to deeply pigmented

How would you describe the undertone of your skin?*

CoolNeutralWarmUnsure

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

Have you undergone any surgery within the last 6 months?*

YesNo

Are you pregnant or breastfeeding? (Female only)

YesNo

Are you currently taking any medications?*

YesNo

Please list any medications here.

What is your desired tanning result?

Acknowledgment:

1. The airbrush tanning process has been explained to me and I hear by agree to allow Coral & Coconut, LLC to apply spray tan solution to my skin using the airbrush tanning process.

2. To my knowledge I have no medical condition or allergy which would preclude me from having this procedure done.

3. I agree to hold harmless Coral & Coconut, LLC and the spray tan technician of any medical complications that may arise and I have been advised to discontinue use if any reaction occurs. Coral & Coconut, LLC and their agents are not liable for any injury to person.

4. I agree to hold harmless Coral & Coconut, LLC and the spray tan technician of any property damage that may be incurred as a result of this treatment including but not limited to discolored clothing, damaged jewelry, discolored surfaces, and damaged home fixtures. Coral & Coconut, LLC and their agents are not liable for any injury to property or the loss or theft of any personal property.

5. I understand that the results of airbrush tanning do vary and there’s no guarantee of specific results that are offered or implied.

6. I hear by release Coral & Coconut, LLC as well as the spray tan technician and hold them harmless from any liability involved in the use of or arising during the tanning process or there after.

DHA is listed in the Food, Drug and Cosmetic Act (FD&C Act) as a color additive for use in imparting color to the human body. However, its use in cosmetics – including sunless “tanning” products – is restricted to external application. According to CFR, “externally applied” cosmetics are those “applied only to external parts of the body and not to the lips or any body surface covered by mucous membrane” (21 CFR 70.3v).

-DHA reacts with the skin’s amino acids resulting in a “tan” similar looking to that of the sun. The darker you can tan naturally, the darker you can tan with a spray tan. Like most cosmetics, avoid exposure to the eyes, lips, and other parts of the body covered with a mucous membrane.

-A spray tan should last 5-10 days, depending on your skin type and how well you take care of your sunless tan. I have been advised to wear loose fitting clothing after the procedure and have been told not to use harsh soaps or exfoliate when showering or bathing after this application. I have been advised not to sweat or come into contact with water for 8 hours following this application.

-Be advised there may be a small percentage of individuals whose skins does not react favorably to spray tanning, some medications such as birth control pills, hormone replacement medications, or antibiotics may alter your tan. Please consult with your technician if you have any questions.

-Coral & Coconut, LLC provides nose filters, eye wear, and Vaseline for your lips at each session. I understand that it is my choice whether I chose to utilize these protective items and I acknowledge that I am using these services at my own risk.

I have read and fully understand and accept this Informed Consent/Release of Liability Form and agree to accept all of the provisions and certify that the information collected is true.

Client's Signature*

Date Signed*

Date

Spray Tanning Consent Form

Consent Agreement