Spray Tan Consent

Spray Tanning Release Form

Please fill in the form below.

Full Name*

First NameLast Name

Birth Date

MonthDayYear

Phone Number*

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E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

1.How did you hear about us?*

2. Are you taking any medications, currently?*

Yes (please list below)No

If yes, please list here:

3. Are you pregnant or nursing?*

YesNo

4. Do you have any allergies:*

Please read, understand and sign the following.

• Spray tanning is accomplished by application of a solution containing the active ingredient: DHA (Dihydroxyacetone). DHA is considered to be safe and has been FDA approved ONLY if you follow guildlines to protect mucous membranes.

The FDA recommends that you take the following measures to protect ingestion or inhalation during your sunless session by using:

Protective eyewear
Nose filters
Sealing lips with lip balm
Protective undergarments

• Before starting your airbrush tan, you will remove clothing for applition. This is up to you and your level of comfort. You should wear a dark swimsuit or underwear. Spa undergarments may be available upon request. The solution will wash out of most clothing. It is always best to wear dark loose fitting cotton clothing. It is advised to wash the undergarment or clothing worn as soon as possible after your session.
• Next, You will be sprayed. This process will take approximately ten to fifteen minutes. After spraying, your skin should be dry before putting your clothes back on and you should not bathe or sweat excessively for nine hours. The solution will give you an immediate bronzing effect. The bronzing effect is a result of a coloring additive in the solution that will remain on the skin until you are actually tan. When you shower, the coloring will come off to reveal your actual tan beneath.

• All people are different. All ingredients used in this procedure are intended for cosmetic use and generally regarded as safe. There are, however, occasions where individuals may be allergic to one or more ingredients in the spray tan solution. Please read the ingredients list if you have any known allergies.

• Be advised there is a small percentage of people whose skin may not react favorably to spray tanning. For this reason, we do NOT advise being sprayed for the first time when your appearance is critical; (wedding/special occasion)

• Caution – Pregnant or nursing women should consult their physician before using. • Warning – This product does not contain a sunscreen and does not protect against sunburn. Repeated exposure of unprotected skin to U.V. Light may increase the risk of skin aging, skin cancer and other harmful effects to the skin even if you do not burn.

I have been provided with spray tan care instructions, which I have read and understand completely. To my knowledge, I have no medical condition or allergy which would preclude me from having this procedure done. I have been honest and accurate about the information that I have provided on this waiver. I take sole responsibility of any reaction I may have, staining of clothing and/or personal belongings. I have read and completely understand this consent form.

NOTE FOR MINORS (Under 18): Waiver must be signed by parent or legal guardian.

I, the parent/legal guardian grant permission for my minor spray tan in front of a female airbrush professional

YesOther

Signature*

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