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LA PLAYA SKINCARE

EL SEGUNDO, CA

CLIENT INFORMATION FORM

AND

WAIVER

LA PLAYA SKINCARE WAIVER

You have agreed to participate in an airbrush tanning session to achieve a "sunless" tan on your skin. To help you best achieve your desired results, please read the following material carefully and acknowledge your understanding and agreement by signing below.

Spray tanning is accomplished by application of a solution containing the active ingredient Dihydrocxaceytone (DHA). DHA is considered to be safe and has been FDA approved in cosmetic use, but it does not contain sunscreen and does not provide any UV protection or protection from the suns harmful rays. Repeated exposure of unprotected skin to UV light may increase the risk of skin aging, skin cancer, and other harmful effects to the skin even if you do not burn. Use SPF sun protection as usual. 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

* Your sunless professional will have all FDA recommended protective items available for you at your appointment.

* Caution- Pregnant or nursing women should consult their physican before using.

* If you have sensitive skin or allergies to sunless products containing DHA/sunless tanning solutions, or if you are unsure whether you may be allergic to DHA or the ingredients in the spray tan solution, we strongly suggest consulting your physician prior to tanning. Please read the ingredients list if you have any concerns or any known allergies.  Allergic reactions such as minor rash are extremely rare, but possible. If you have never used a sunless tanning product, we suggest a patch test 24 hours before the full body application. La Playa Skincare and the spray tan technician are not responsible for any allergic or adverse reactions that may occur after or during use.

* If you have a history of asthma or other respiratory or medical conditions that could be aggravated by the use of the airbrush tanning process, please consult a physician before proceeding. Inform your spray tan technician about any past allergic reactions with DHA products or other concerns. La Playa Skincare and the spray tan technician are not responsible for any aggravation of any medical conditions or reactions that may occur after or during use.

* Some of the ingredients in our solution contain a sugar base and application can cause a rise in blood sugar levels. If you are a diabetic or have medical conditions that can be affected or aggravated by a rise in blood sugar, please consult your physician before use.

* You should prepare your skin for your session prior to your arrival. Skin should be free of deodorant, sweat, fragrances, lotions, and it should be clean, dry, exfoliated (removal of dead, dry skin cells) and shaved. Remove all make-up and do not wear jewelry of any kind. If you attend an airbrush tanning session without proper preparation, La Playa Skincare and its technicians cannot guarantee lasting or satisfactory results.

* All people are different.. 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 critcal (Wedding/special occasion).​​

* The bronzing and tanning solutions used during your session have the potential to stain clothing.  We recommend that you wear something dark in color that can be stained without concern, such as an old swimsuit or undergarments. Some clients purchase an inexpensive swimsuit dedicated to their tanning sessions. For your convenience, disposable thong underwear, which create minimal tan lines are available from your technician. After your tanning session, you should wear dark, loose fitting clothes.

* It is also possible that the solution may transfer to other clothing, furniture, or car seats after your session. Washing or dry-cleaning will usually, but not always, remove the color. We suggest bringing a towel to cover your car seat.

* La Playa Skincare and its technicians are not responsible for potential stains to hair, clothing, carpeting, flooring, walls, or upholstery. Please be conscientious and careful.

* Your tanning session will take approximately 15-20 minutes. After spraying, your skin should be dry before putting your clothes back on and you should not bathe, shower, or sweat excessively for 8-9 hours for the original tan or 2-4 hours for the rapid tan. Exposure to excess moisture before this time period may affect your results. When your session is over the solution will give you an immediate bronzing effect. When you bathe, the bronzer will come off and your true tan color will continue to develop over 24 hrs. Please be advised your tan outcome can be affected by your hormone levels, cycle time, certain facial/body products, medication use or a medical condition. 

* La Playa Skincare and its technicians will not be held responsible for lost, stolen, or damaged personal items.

*The airbrush tanning process has been explained to me and I herby agree to allow La Playa Skincare and its technicians to apply spray tan solution to my skin using the airbrush tanning process.

* To my knowledge, I have no medical condition or allergy which would preclude me from having this procedure done. I agree to hold harmless of any medical complications that may arise and I have been advised to discontinue use if any reaction occurs. I understand that the results of airbrush tanning do vary and that no guarantees of specific results are offered or implied. I herby release this establishment, as well as the airbrush technician, and hold them harmless from any liability involved in the use of or arising during the tanning process. I also agree to first contact La Playa Skincare if for any reason I am dissatisfied with my results. 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.

Date Signed: June 24, 2019

First Participant's Name

First Name*

Last Name*

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

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

Parent or Guardian's Email Address

Email*

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

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

Last Name*

Relationship*

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

Email: *

Time of your appointment *

Date of your appointment *
May we send you text or email correspondence?*
No
Yes

How did you hear about us? *

If you were referred, who can we thank?
Is this your first spray tan?*
No
Yes
Is your spray tan for a special occasion?*
No
Yes
Are you interested in a spray tan solution that can be showered off more quickly?*
No
Yes
Are you pregnant?*
No
Yes
Maybe
Are you nursing?*
No
Yes
Do you have asthma?*
No
Yes
Do you wear contacts*
No
Yes
Do you have any allergies? (Please read our products ingredient list if you have any concerns or known allergies)*
No
Yes
Do you use acne medication?*
No
Yes
Do you use any skin care products containing any of the of following: retinol, AHA products, BHA products, moisturizing soaps, facial masks, or pore strips?*
No
Yes
Do you have any skin issues?*
No
Yes
We do not recommend tanning is you have a new tattoo or open skin wounds. Do you currently have any open skin wounds or new tattoos?*
No
Yes
Tell us a little bit about your skin type:*
Please tell us if your skin is:*
The type of tan you want is:*
I have read and understand the pre-tan and post tan care instructions located under the Skin Care tab on the La Playa Skincare website: www.laplayaskincare.com.*
No
Yes

Please arrive with clean skin- free of makeup, sweat, deodorant, perfumes, lotions, oils, and toners. Get all your spa treatments done PRIOR to your tanning session. This includes facials, manicures, pedicures, waxing (waxing should be done 1-2 days prior to tanning), hair appointments, and massage.

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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