Please read the following and sign at the bottom where indicated if you agree.
1. Using a Tanning Device.
A. A person who uses a tanning device in this tanning facility must use eye protection.
B. If eye protection is not worn, use of a tanning device in this facility may cause damage to the eyes.
C. Overexposure to the ultraviolet radiation produced by a tanning device in this facility may cause burns. A painful, blistering sunburn prior to the age of eighteen can significantly increase the risk of skin cancer/melanoma.
D. Repeated exposure to the ultraviolet radiation produced by the tanning devices in this tanning facility may cause premature aging of the skin, skin thickening, and skin cancer.
E. Abnormal skin sensitivity to ultraviolet radiation or burning may be caused by certain foods, cosmetics, or medication, including, but not limited to, the following:
1. Tranquilizers;
2. Diuretics;
3. Antibiotics;
4. High blood pressure medication;
5. Birth control medication; and
6. Other photosensitizing agents
F. An individual who is taking a prescription drug or over-the-counter drug should consult a physician before using a tanning device.
G. A person who is less than Sixteen (16) years of age must be accompanied by a parent or guardian when using a tanning device in this facility.
H. A person who is less than Eighteen (18) years of age may not use a tanning device in this facility unless the parent or guardian has also signed this written tanning release form. The form must be signed in the presence of the operator of the facility.
I. Different skin types respond differently to tanning.
J. Tanning may be inadvisable during pregnancy and for persons with photosensitizing disease, melanoma or other skin cancers. Tanning may cause possible activation of some viral conditions (cold sores) etc.
2. I agree that I will comply with all instructions on the use of the UV system and that I am using these services at my own risk.
3. I agree to hold harmless all Champion Fit LLC, its employees and agents for any injury to person or property in any way by the use of its premises and services. In addition, they are not liable for the loss or theft of any personal property. Each person is responsible for safeguarding his or her own property.
4. Purchaser agrees to use all sessions within the terms of the contract dates and understands that refunds are never given on unused portions of tanning packages for any reason.
5. I understand that it is against policy to tan in more than one indoor tanning salon in one day.
6. Tanning is available during staffed gym hours.
7. Baby oil or other outside products are prohibited.
8. Tanning purchases are non-transferrable. This means you MAY NOT under any circumstances allow anyone else to use your tanning package.
9. Waiver, Release and Consent
A. Having been advised and fully informed by Champion Fit LLC hereinafter called Champion Fit LLC, concerning the nature of the sun tanning process proposed to be administered including the effects of such process and the possible risks and consequences of exposure to the indoor sun tanning equipment used in such process, I hereby authorize and direct them to administer such indoor tanning process and perform such indoor tanning procedures as may be deemed necessary or advisable. I hereby confirm that no warranty or guarantee, or other assurance, has been made to me covering the results of the indoor sun tanning process. I fully understand the administration of the indoor sun tanning process, including possible adverse skin reactions, side effects, or other possible complications. It is understood that this Waiver, Release and Consent is being given in advance of any administration of the process, and is being given by me voluntarily to induce the Facility to exercise their best judgment as to the manner and requirement of administering the sun tanning process, and procedures to me.
B. My signature below constitutes my acknowledgment that:
1. I have read, understand, and fully agree to the foregoing Waiver, Release and Consent,
2. The proposed indoor sun tanning process has been satisfactorily explained to me and I have all of the information I desire and
3. I hereby give my authorization and consent which shall continue in effect as long as I tan with any Facility location now and in the future.
I have read the instructions for proper use of the tanning facilities and shall use such tanning facilities at my own risk. For and in consideration of said being allowed to use the facilities of Champion Fit LLC, I hereby release Champion Fit LLC, its directors, officers, and employees from all liability to me for any loss or damage to property or injury or death to me whether caused by Releasees or otherwise that result, directly or indirectly from the use by me of the tanning facilities of Champion Fit LLC.
DANGER: Ultraviolet radiation. Follow instructions. Avoid Overexposure. As with natural sunlight, overexposure can cause eye and skin injury and allergic reactions. Repeated exposure may cause premature aging of the skin and skin cancer. WEAR PROTECTIVE EYEWEAR. FAILURE TO DO SO MAY RESULT IN SEVERE BURNS OR LONG TERM INJURY TO THE EYES.
WARNING: Receive proper operation instructions from the proprietor. When using a machine with a bench and canopy, pull the canopy down until it will move no further. Recommended distance of the body from the canopy of this machine should be 6 inches or 15 cm. Operation of any sunbed closer to the body than recommended minimum distance for use may result in overexposure.
MEDICATIONS OR COSMETICS: Some may increase your sensitivity to ultraviolet radiation. Consult a physician before using sunlamps. If you are using medications , have a history of skin problems, or believe you are especially sensitive to sunlight. If you do not tan in the sun, you are unlikely to tan from use of this product. Tanning may appear after one application provided that your skin is capable of developing suntan. Allow 48 hours between sessions to obtain a base tan, and once or twice per week to maintain appearance.
RECOMMENDED EYEWEAR: Provided eye shields, such as Intrexco Nr. 563511s, or equivalent eyewear as defined by 21 CFR 1040.20, 2 (b) (6). One pair of protective eyewear is furnished with this equipment and should be worn by all persons in the room when te lamps are on. INSURE THAT THE SUNBED USED CONTAINS COMPATIBLE LAMP TYPES AS THOSE LISTED THEREON. ALL SUNBEDS MUST HAVE A LABEL STATING COMPLIANCE WITH PERFORMANCE STANDARDS FOR SUNLAMP PRODUCTS UNDER 21 CFR PART 1040.20.
{signature}