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Beautifully Bronze  

1528 Poole Blvd Suite A

Yuba City, Ca 95993

 

 

Please read, understand, and sign the following:

Airbrush tanning is accomplished by application of a solution containing the active ingredient: DHA (Dihydroxyacetone). DHA is generally considered to be safe and has been FDA approved ONLY if you follow guidelines to protect mucous membranes. The FDA advises asking the following questions when considering the application of DHA products by spraying:

1. Are you protected from exposure in the entire area of the eyes, in addition to the eyes themselves?

2. Are you protected from exposure on the lips and all parts of the body covered by mucous membrane?

3. Are you protected from internal exposure caused by inhaling or ingesting the product?

If the answer to any of these questions is "no," you are not protected from the unapproved use of DHA. You should request measures to protect your eyes and mucous membranes and prevent inhalation.

- You will be guided to the airbrush tanning area where you will dress down to your comfort level. Disposable undergarments are available upon request. Understand that the solutions bronzer will wash out of most clothing. It is advised to wash any clothing worn as soon as possible after your session. It is recommended to wear dark, loose fitting cotton clothing after your appointment.

- Your technician will airbrush you. This process will take approximately ten to fifteen minutes. After application, your skin will be dried and powdered before you dress. Do not bathe or sweat excessively for the recommended amount of processing time. The solution may give you an immediate bronzing effect. This bronzing effect is a result of a temporary coloring additive in the solution that will remain on the skin until your first rinse. During your first rinse, the coloring will come off to reveal your sunless tan produced by DHA beneath.

- All people, all skin, is different: All ingredients used in this service 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 airbrush solution. Please request a copy of the ingredients list if you have any known allergies and discuss alternative options with your technician.

- Be advised there is a small percentage of people whose skin may not react favorably to airbrush tanning. For this reason, we do NOT advise being sprayed for the first time when your appearance is critical: (Wedding, Photo Shoot, Prom, etc.) Please schedule a trial session at least four weeks before your event, for best results.

- Pregnant or nursing women agree to consult their physician before making an appointment. Airbrush tanning is not normally contraindicated when a mask or nose filters are used, but each pregnancy is different. Your medical care provider may prefer a more cautious approach based on your specific needs and health concerns.

- We reserve the right to refuse to spray anyone who has a sunburn. It is not advised to spray tan over a burn as it will result in peeled skin that can last 5-10 days. You, the client, assume all responsibility if your tan reacts from any peeling skin after sun exposure or from cosmetic procedures such as lasers or chemical peels without informing your technician prior.

- This product does not contain a sunscreen and does not protect against sunburn. 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.

Beautifully Bronze will not be responsible for damaged personal items. The airbrush tanning process has been explained to me and I hereby agree to allow Beautifully Bronze 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 Beautifully Bronze 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 hereby 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 Beautifully Bronze if for any reason I am dissatisfied with my results.

In addition, I affirm that I am in good health and have not been in contact with anyone experiencing symptoms of COVID-19 as detailed by the CDC.

I have read and completely understand the conditions of this information form.

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
Participant's 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
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
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.

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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Have you received a spray tan or applied sunless tanner before?*
No
Yes

List any known allergies:
Do you have any skin conditions?*
No
Yes

If yes, please list
Do you have any respiratory illnesses?*
No
Yes
Are you or could you be pregnant?*
No
Yes
Are you currently breast-feeding?*
No
Yes
If yes, do you have permission from your doctor to tan?*
No
Yes
Are you under doctors care presently?*
No
Yes

If yes, please list the medical condition
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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