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Airbrush Tanning Waiver

Spray tanning is a process in which DHA (dihydroxyacetone) is applied to your skin. Glowout operates on the highest ethical standards in regards to client safety. Masks are provided for client use and cover the nose and mouth as well as disposable undergarments to protect mucus membranes. All ingredients are generally regarded as safe, however, occasionally a client can have an allergy present after receiving a spray tan. This product does not contain sunscreen nor protect you from UV damage. The results of spray tanning can vary depending on your preparation process and lifestyle post spray tan. We will do our best to prepare you for the best tan possible. Please inform us of any medical/health issues you may have prior to your tanning experience. This is including but not limited to airborne allergies, past or present skin reactions or irritations, topical or oral medications/products currently or recently in use, retinol or Vitamin A usage, asthma conditions, hormonal issues, recent food illnesses, and other stressors. Pregnant or nursing mothers are kindly asked to obtain a written note from your doctor prior to airbrush tanning.

I understand this process and am very excited to get my glow and hereby agree to all Glowout employees to apply spray tan solution to my skin. I further acknowledge that although allergic reactions are uncommon, they can occur and I agree to contact Glowout immediatley. To my knowledge, I have no medical conditions or allergies which would prevent me from receiving an airbrush tan at this time. I agree to not hold Glowout responsible of any medical complications that may arise and have been advised to stop spray tanning if reactions occur. I understand this process and agree I am ready to feel amazing and look ten pounds thinner today!

First Client's Name

First Name*

Middle Name

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
First Client's Signature*
Second Client's Name

First Name*

Middle Name

Last Name*

Phone*
Second Client's Date of Birth*
Second Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Third Client's Name

First Name*

Middle Name

Last Name*

Phone*
Third Client's Date of Birth*
Third Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Fourth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Client's Date of Birth*
Fourth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Fifth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Client's Date of Birth*
Fifth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Sixth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Client's Date of Birth*
Sixth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Seventh Client's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Client's Date of Birth*
Seventh Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Eighth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Client's Date of Birth*
Eighth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Ninth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Client's Date of Birth*
Ninth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Tenth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Client's Date of Birth*
Tenth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
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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