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SUNKISSEDBYCHRIS CUSTOMIZED AIRBRUSH TANNING
CLIENT INFORMATION & CONSENT FORM

Please read, understand and sign the following:

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 mucous membrane” (21 CFR 70.3v).

  • 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.  Like most cosmetics, avoid exposure to the eyes, lips, and other parts of body covered with a mucous membrane.  This should be accomplished by follow the staff’s breathing instructions as to avoid inhaling or ingesting the sunless product and by applying a barrier cream.
  • Your spray tan should last 8-16 days depending on your skin type and how well you take care of your sunless tan.  It’s very important to keep your skin moisturized after your spray tan, avoiding long baths or showers and hot tubs.
  • Be advised there may be a small percentage of individuals whose skin does not react favorably to spray tanning.  Some medications such as birth control pills, hormone replacement medications, or antibiotics may alter your tan.  Please consult with your technician if you have any questions.
  • All ingredients in the product used in this procedure are all natural, organic, 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 spray tan solution.  If this occurs, shower, exfoliate and discontinue use.  If severe reaction, contact a physician.  You may ask to see the ingredients prior to application
  • Be advised we do NOT advise being sprayed for photographic sessions, modeling assignments, weddings, etc. UNLESS you have had a trial spray tan prior.

I have read the contents of this consent form carefully and state that I am not aware of any medical condition, allergies, or other reason that would prohibit me from sunless tanning.  I have been given adequate instructions for the proper use of the sunless application, understand the risks involved, and use it at my own risk.  I hereby agree to release the owners, operators and manufacturers from any damages that I might incur due to the use of this facility.  I have been advised to discontinue use if any reaction occurs.

I have read and completely understand this consent form.

Today's Date: April 9, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
Have you received a spray tan or applied a sunless tanner before?*
No
Yes

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's care presently?*
No
Yes

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

First Name*

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

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's care presently?*
No
Yes

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

First Name*

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

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's care presently?*
No
Yes

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

First Name*

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

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's care presently?*
No
Yes

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

First Name*

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

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's care presently?*
No
Yes

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

First Name*

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

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's care presently?*
No
Yes

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

First Name*

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

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's care presently?*
No
Yes

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

First Name*

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

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's care presently?*
No
Yes

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

First Name*

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

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's care presently?*
No
Yes

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

First Name*

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

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's 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*

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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Have you received a spray tan or applied a sunless tanner before?*
No
Yes

List any known allergies
Any related to Dihydroxyacetone (DHA)?*
No
Yes
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
If yes, do you have permission to tan?
Are you under a doctor's 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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