Spray Tanning Waiver/Consent Form

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

DOB*

Date

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Referred By (name of friend, search engine, etc)

Reason for Spray Tanning*

Have you ever had a Spray Tan or used sunless tanning products in the past?*

What is your opinion ideal depth of color?*

Do you have any known allergies or skin sensitivities?*

If YES, please list:

If YES to known allergies or sensitivities, please list:

What is your skin type?*

What is your skin tone?*

Very Fair - Always BurnsFair - Always Burns, Sometimes TansMedium - Sometimes/Rarely Burns, Always TansDark - Never Burns, Always Tans

I have read and followed the pre-tan instructions that have been emailed to me - that can also be found on the FAQ page at GlowVibesOnly.com.*

I have showered and applied NO products to my skin (ex. Moisturizer).*

Do you understand that freckles and birthmarks may darken with Spray Tan?*

Do you understand that acne products and certain anti-aging products (ex. retinoids) may make Spray Tan look uneven?*

Sun/UV exposure & sunburns DO NOT mix well with Spray Tanning. Do you understand that previously sunburned or suntanned skin may result in an uneven or peeling Spray Tan?*

DHA is listed in the Food, Drug and Cosmetic 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). This product does not contain a sunscreen and does not protect against sunburn.

● DHA reacts with the skin’s amino acids resulting in a “tan” similar looking to that achieved by 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. This should be accomplished by the following the staff’s breathing instructions as to avoid inhaling or ingesting the sunless product.

● Be advised there may be a small percentage of individuals whose skin 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.

I read and understand the Ageless Tans LLC Consent Form and agree to the above waivers of liability.*

Client Signature*

Parent/Guardian Name (If client is under the age of 18, a parent/guardian signature is required for services.)

I agree to the terms and conditions of this document on behalf of myself or as the parent or legal guardian of the minor on whose behalf I am signing this document. I agree and understand that by signing and submitting this Spray Tanning Waiver/Consent form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.*

I Agree