Spray Tanning Waiver of Liability
Please complete this form to acknowledge and accept the terms, risks, and conditions of receiving spray tanning services at Bella Day Spa.
Full Name
*
First Name
Last Name
Address
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Have you ever had an allergic reaction to ANY self-tanning product?
*
Yes
No
If yes, please explain:
Do you have Tinea Versicolor (a common fungal infection)?
*
Yes
No
Are you pregnant?
*
Yes
No
Are you breastfeeding?
*
Yes
No
Are you under 18 years of age?
*
Yes
No
I understand that swimming, showering, and/or participating in any vigorous activity that results in sweating can negatively impact the result of my spray tan if done within 8 hours of application.
*
I agree
I understand that there is a chance of my clothing to be stained.
*
I agree
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Full Name (Release Signature)
*
First Name
Last Name
Client’s Signature
*
Esthetician Initial’s
Submit Waiver
Submit Waiver
General Release of Liability
The Food & Drug Administration (FDA) approved Dihydroxyacetone (DHA) for topical body use only. The FDA advises that all users of DHA spray tanning services avoid inhaling or ingesting DHA. When using sunless tanning sprays, it may be difficult to avoid exposure to mucous membranes (eyes, nose and mouth). If you elect to have your face sprayed, you have the right to request protective wear for your eyes, nose and mouth.
In consideration of receiving to participate in any activities sponsored by or provided on the premises of Bella Day Spa, or to utilize or otherwise obtain any services, products or goods offered or sold by, or on the premises of Bella Day Spa, the receipt of such permission being also acknowledged, each of the undersigned releases Bella Day Spa, its members, managers, agents, officers, servants and employees of and from any and all liability, claims, demands, actions and causes of action whatsoever, arising out of or related to any loss, damage, injury to person or to property (including clothing), including death, that may be sustained by any or each of the undersigned, or any property of any or each of the undersigned, while in or on the premises, or any premises leased to, owned by, sanctioned by, or under the control or supervision of Bella Day Spa or en route to or from any of the premises.
Each of the undersigned being duly aware of the risks and hazards inherent in entering on the premises and/or in participating in any activities involving Bella Day Spa, voluntarily and knowingly assume all risks or loss, damage, or injury, including death, that may be sustained by any or each of the undersigned arising from the application of the spray tan products.
This release is binding on the undersigned heirs, next of kin, executors, administrators, and personal representatives of each of the undersigned.
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