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Airbrush Tanning Consent Form

I attest that I do not have any known allergies

I Agree

I attest that I do not have any skin conditions that will prevent me from spray tanning

I Agree

I attest that I do not have any respiratory illnesses that will prevent me from spray tanning & if I do I have a doctors permission

I Agree

I attest that I am not pregnant and if I am I have permission from a doctorto spraytan

I Agree

I attest that I am not under any doctors care and if I am I have medical clearance to spray tan

I Agree

Please read, understand and sign the following:

DHA is listed in the Food, Drug and Cosmetic Act (FD&C 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).

DHA reacts with the skins amino acids resulting in a tan similar looking to that of 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 body covered with a mucous membrane. This should be accomplished by following the staffs breathing instructions as to avoid inhaling or ingesting the sunless product.

Your spray tan should last 5-10 days, depending on your skin type and how well you take care of your sunless tan. It is very important to follow post tan instructions, keep your skin moisturized after your spray tan, avoid long baths, showers and hot tubs. Saltwater exposure or a chlorinated pool can also shorten the life of your spray tan and cause patching or streaking.

It is uncommon however please be advised there may be a small percentage of individuals whose skin does not react favorably to spray tanning. There is no way for the spray tan tech or owner to know how your body will react. Perfect Glow Sunless Inc is not liable for any allergic reaction or illness resulting from your spray tan session. Some medications including (but not limited to) birth control pills, hormone replacement medications, antibiotics or menstrual cycle may alter your tan. Please consult with your technician prior to your session if you have any questions.

All ingredients in the products used in this procedure are intended for cosmetic use and generally regarded as safe. There are, however, occasions where individuals may find to be allergic to one or more ingredients in the spray tan solution. If this occurs, shower and discontinue use and seek medical attention. You may ask to see the ingredients prior to application. If you suffer from Asthma, please consult a physician to determine if spray tanning is OK for you. If you are pregnant, please contact your doctor for permission prior to your session. Clients in their last trimester will need to provide a doctor note authorizing them to airbrush tan. You agree to tan at your own risk.

Be advised we do NOT advise being sprayed for any photographic sessions, modeling assignments, weddings, or special occasions etc. unless you have had a trial spray tan with us. Spray tan at your own risk &we are not responsible for any dissatisfaction or damages resulting from your decision to not have a trial session.

Following the spray tan session, please follow the directions provided including to avoid: tight clothes, excessive perspiring, leather seats, Some fabrics may be stained by the spray tanning solution-please use caution and care.

DHA the active ingredient is FDA approved for application to non-mucous membranes The FDA recommends that you take the following measures to protect against ingestion or inhalation during your sunless session by using:

Protective eyewear, Nose filters, sealing lips with lip balm, protective undergarments.

WARNING This product does not contain a sunscreen and does not protect against sunburn. Repeated exposure of unprotected skin may increase the risk of skin aging, skin cancer and other harmful effects to the skin even if you do not burn.

I have read the contents of this consent form carefully and state that I am not aware of any medical condition, allergies, breathing or respiratory issues, or any other reason that would prohibit me from sunless tanning. I have been given adequate instructions for the proper use of the sunless application & have been offered a shower cap, nose plugs, eye covers or face mask if I choose to use one . Perfect Glow Sunless is not aware of your medical history or can predict how you (the client) will react to a session and is performing this service solely based on the information provided by the the client. If any discomfort, faintness or light headiness should occur the session will be immediately stopped and if necessary, the establishment will seek medical assistance on your behalf. You hereby agree to release Perfect Glow Sunless Inc, the owners, property owner, operators and manufacturers from any damages or injury or allergic reaction that you may incur due to the use of this facility or service. You have been advised to discontinue use if any reaction occurs, understand the risks involved, and tan at your own risk. There are no refunds for services and resprays are at the discretion of management. This consent form is good indefinitely. It is the sole responsibility of the client to notify Melissa Weinberg about any changes in allergies or medical conditions. Client agrees to allow Perfect Glow Sunless to use any photos provided to them by the client at or after their session for unlimited use in website, advertising publications and social media content indefinitely. Perfect Glow Sunless has the right to refuse service.

I have read and completely understand this consent form.

I Agree

 

 


First Client Name

First Name*

Last Name*

Phone*
First Client Date of Birth*
First Client Signature*
Second Client Name

First Name*

Last Name*
Second Client Date of Birth*
Second Client Signature*
Third Client Name

First Name*

Last Name*
Third Client Date of Birth*
Third Client Signature*
Fourth Client Name

First Name*

Last Name*
Fourth Client Date of Birth*
Fourth Client Signature*
Fifth Client Name

First Name*

Last Name*
Fifth Client Date of Birth*
Fifth Client Signature*
Sixth Client Name

First Name*

Last Name*
Sixth Client Date of Birth*
Sixth Client Signature*
Seventh Client Name

First Name*

Last Name*
Seventh Client Date of Birth*
Seventh Client Signature*
Eighth Client Name

First Name*

Last Name*
Eighth Client Date of Birth*
Eighth Client Signature*
Ninth Client Name

First Name*

Last Name*
Ninth Client Date of Birth*
Ninth Client Signature*
Tenth Client Name

First Name*

Last Name*
Tenth Client Date of Birth*
Tenth Client Signature*
Client Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Any allergies

Please list *
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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