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Danger – ULTRAVIOLET RADIATION

  • Follow operator, tanning unit, eyewear and safety instructions.
     
  • Exposure to the tanning process may cause skin cancer. Regular tanners should be regularly screened for skin cancer.
     
  • Avoid too frequent or lengthy exposure. As with natural sunlight, exposure to a sunlamp may cause eye and skin injury, sunburn, and allergic reactions.
     
  • Repeated overexposure may cause chronic damage characterized by wrinkling, dryness and premature aging of the skin.
     
  • Wear protective eyewear. FAILURE TO USE PROTECTIVE EYEWEAR MAY RESULT IN SEVERE BURNS OR LONG-TERM INJURY TO THE EYES.
     
  • Abnormal or increased skin sensitivity or burning may be caused by certain foods, medications, (included but not limited to tranquilizers, diuretics, antibiotics, high blood pressure medication, birth control pills and skin creams) cosmetics, or toiletries. Consult a physician or pharmacist before using a sunlamp if you are using prescription or non-prescription medications, have a history of skin problems, or believe yourself especially sensitive to sunlight. Pregnant women and women on birth control pills who use tanning device may develop discolored skin and should consult a physician before tanning.
     
  • Ultraviolet radiation from sunlamps enhances the effects of the sun. Do not sunbathe before or after exposure to ultraviolet radiation.
     
  • Clients takes full responsibility for any abuse or misuse of tanning equipment or related products.

I understand and agree that all Sessions will expire 2 years from the date of purchase and that all sales are final. 

I have read and understand this warning and will hold Lux Tan, its affiliates, et al harmless of any adverse effects or events resulting from UV exposure or use of any of its tanning products and services. Furthermore, I understand ALL SALES ARE FINAL AND NONREFUNDABLE. Lux Tan reserves the right to cancel my membership at any time.

Date: October 26, 2021

First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
Second Client's Signature*
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
Third Client's Signature*
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
Fourth Client's Signature*
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
Fifth Client's Signature*
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
Sixth Client's Signature*
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
Seventh Client's Signature*
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
Eighth Client's Signature*
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
Ninth Client's Signature*
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
Tenth Client's Signature*
Client'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.
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
How did you hear about us?
How did you hear about us?*
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
Skin Type:*
Are you currently taking any photosensitizing medications?*
No
Yes

Please list any and all prescriptions/nonprescription medications, and all allergies to cosmetics, toiletries, and tanning accelerators.
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant?*
No
Yes
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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