Liability Waiver - Stand Up Tanning UNDER 18
Date:
-
Month
-
Day
Year
Date Picker Icon
1. Name:
*
2. Phone Number:
Please enter a valid phone number.
3. How long has it been since you tanned?
4. Do you tan easily?
*
Yes
No
5. Are you currently sunburned on any part of your body?
*
Yes
No
6. Do you have a tendency to burn?
*
Yes
No
7. Do you have allergies to sunlight?
*
Yes
No
8. Do you wear contact lenses?
*
Yes
No
9. Are you taking any medication that may cause photosensitivity?
*
Yes
No
If yes, please list:
10. Have you ever had a severe sunburn?
*
Yes
No
If yes, when?
11. Have you ever been advised by a Doctor to stay out of the sun?
*
Yes
No
If yes, why?
*
12. Please choose what best describes your skin out of the following options:
*
Always burn, never tan
Usually burn, sometimes tan
Sometimes burn, always tan
Never burn, always tan
IT IS OUR INTENTION TO KEEP YOU WELL INFORMED ABOUT TANNING. THIS INCLUDES INFORMING YOU ON HOW TO OPERATE THE EQUIPMENT AS WELL AS HOW TO TAN RESPONSIBLY. THE PROPER PROCEDURE TO FOLLOW IN THE TANNING ROOM WILL BE CLEARLY EXPLAINED TO YOU BY THE TANNING TECHNICIAN. PLEASE FEEL FREE TO ASK ANY QUESTIONS OR TO VOICE ANY CONCERNS THAT YOU MAY HAVE AT THIS TIME. OUR GOAL IS TO HELP YOU ACHIEVE THE BEST POSSIBLE TAN, RESPONSIBLY.
By filling in your name below, you are agreeing that you understand the following:
PLEASE SIGN YOUR NAME TO SHOW YOU HAVE READ AND UNDERSTAND THE FOLLOWING GUIDELINES WHEN TANNING: 1. Avoid overexposure. As with natural sunlight, overexposure can cause eye and skin injury and allergic reactions. Repeated overexposure has been known to cause premature aging and skin cancer. 2. Please inform us if you are taking any sun sensitive medications. Some medications or cosmetics may increase your sensitivity to UV rays. Please consult a physician before tanning if you are taking any such medications or have a history of skin problems or believe yourself to be especially sensitive to sunlight. I UNDERSTAND THAT IF I AM CURRENTLY TAKING THE MEDICATION PSORALEN, I AM NOT TO CONTINUE WITH TANNING IN BEAUTY VALLEY SPAS TANNING FACILITY, AS IT MAY CAUSE SERIOUS HARM. 3. I will not tan without protective eyewear in Beauty Valley Spa. I understand I am required to wear protective eyewear for every session. Never remove your eyewear when the equipment is on. Failure to wear goggles may result in severe burns or injury to the eyes. Notify our staff if you do not have personal protective eyewear. 4. I understand it is recommended that I use an indoor tanning lotion for more positive results. Mineral oil, baby oil, outdoor tanning oils, and lotions, etc. are harmful to the tanning bed acrylics. Please do not use any lotion that is not intended for indoor use and/or has not been approved by one of our staff. Using these items may result in the loss of your package or minutes without notice. 5. I understand and have been made aware that I should only tan once in a 24 hr period. We promote responsible tanning and do not allow double sessions or tanning more than once a day. 6. If you are pregnant or there is a chance you might be pregnant then you should not tan. Tanning while pregnant may be hazardous to your health. If you are tanning for medical reasons, then you must consult a physician before tanning. Other things you should know: *Your session times are determined according to your skin type, tanning history as well as the condition of our tanning lamps and not by the maximum exposure times of the tanning units. We understand that you may have been tanning elsewhere but we know our equipment the best; please follow our advice. Failure to follow said advice may result in burning for which we cannot be held responsible. *Please try to be early to your appointments; we may not be able to honor your appointments if you are late. *Cleanliness is VERY important to us. We sanitize the room door handles, the chair, the handles/controls on the beds, and the acrylics after every session. *Our staff are Smart Tan Certified and work hard to ensure that you receive the safest and most comfortable tanning experience possible. *We will Assist you in obtaining your desired level of tan with our tanning knowledge and experience. Beauty Valley Spa will also be able to assist with choosing the lotion best suited for your skin type and tanning objectives. *****I have been given instructions for the proper use of equipment and I will use at my own risk. I hereby release the owner, operators, and manufacturers from any damages that I might incur due to the use of the tanning units in this facility.
13. Client (Minor) Name:
*
14. PARENT/GUARDIAN CONSENT (Required for clients under 18) I, the undersigned, am the legal parent or guardian of the minor named above. I give my full consent for them to receive tanning services at Beauty Valley Spa & Salon:
*
Submit
Should be Empty: