BlushTan Bellingham Spray Tanning Release Form Please read, understand and sign the following. Spray tanning is accomplished by application of a solution containing the active ingredient: DHA (Dihydroxyacetone). DHA is considered to be safe and has been FDA approved ONLY if you follow guidelines to protect mucous membranes. 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 a mucous membrane" (21 CFR 70.3v) The FDA advises asking the following questions when considering the application of DHA by spraying or misting - Are you protected from exposure in the entire area of the eyes, in addition to the eyes themselves? Are you protected from exposure on the lips and all parts of the body covered by a mucous membrane? 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. During the appointment, you will enter a private room where you will remove your clothing. This is up to you and your comfort level. Disposable undergarments are available upon request. The solution will wash out of most clothing. It is always best to wear dark, loose-fitting cotton clothing. It is advised to wash the undergarment or clothing worn as soon as possible after your session. DHA reacts with the skin's 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. If you burn easily in the natural sun, you will not be able to use a high amount/level of DHA (spray tanning solution) for risk of looking unnatural results. Your consultant will discuss this with you and determine/recommend the most natural color option for your skin tone. The solution will give you an immediate bronzing effect. The bronzing effect is a result of a coloring additive/cosmetic bronzer in the solution. When you shower, the bronzer will come off to reveal your actual spray tan results beneath. All ingredients used in our spray tanning solutions are intended for cosmetic use and generally regarded as safe. There are, however, occasions where individuals may be allergic to one or more ingredients. Please read the ingredients list if you have any known allergies. 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 critical; (wedding/special occasion). Some medications such as birth control pills, hormone replacement medications, or antibiotics may alter your tan. Caution – Pregnant or nursing women should consult their physician before using. Warning – This product does not contain a sunscreen and does not protect against sunburn. Repeated exposure of unprotected skin to U.V. Light may increase the risk of skin aging, skin cancer and other harmful effects to the skin even if you do not burn. I have been provided with spray tan care instructions, which I have read and understand completely. To my knowledge, I have no medical condition or allergy which would preclude me from having this procedure done. I have been honest and accurate about the information that I have provided on this waiver. I take sole responsibility for any reaction I may have, staining of clothing and/or personal belongings. I have read and completely understand this consent form. Date: November 20, 2024 | 