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CLIENT PROFILE & RELEASE

Client Profile & Release 

I have chosen to use the tanning equipment being offered by Sun Seekers Tanning Ltd and in consideration of permitting me to use the tanning equipment I do fully and unconditionally agree to acknowledge the following:

1) I am fully aware of, freely accept, and fully assume all the risks of injury, illness and aggravation of medical conditions that are, or may be, inherent in the use of tanning equipment. I represent to Sun Seekers Tanning that I have been advised to consult with my family physician or other health authority regarding my intention to use the tanning equipment and that I am otherwise healthy and capable of using such equipment.

2) I hereby discharge, relinquish, waive and release Sun Seekers Tanning and/or its officers, directors, agents, servants, volunteers, employees, other tanning participants, parent company, subsidiaries and affiliates (all of whom are collectively referred to as “Releasees”) from any and all loos, damage, expense, injury, accident, and/or liability of any kind or nature whatsoever in connection with my use of tanning equipment, including injury or death.

3) I further indemnify, save, defend and hold harmless Sun Seekers Tanning and the Releasees from all claims, actions and/or expenses which might arise from any use of the tanning equipment.

4) I hereby sign and deliver this Release and Indemnification to Sun Seekers Tanning to permit my use of the salon’s tanning equipment and I hereby acknowledge that such use is at my own risk and without any representation of any kind or nature having been made by Sun Seekers Tanning or the Releasees.

5) Eye protection is mandatory for protecting vision and is available at Sun Seekers Tanning.

6) I allow Sun Seekers Tanning Salon to contact me via email or text

Cocoon Welness Pro System Waiver

This portion needs to be in place just in case you intend to use the POD in the future it does not related to the UV Tanning equipment. It is our intent to keep you as well informed about our services as possible. Please read the following information and acknowledge that you understand and accept all provisions by signing below.

It is important that you inform our staff if you have any of the conditions listed below under “contraindications for use of the Cocoon Wellness Pro System” before undertaking sauna (heat) and/or vibratory massage treatments.

The Cocoon Wellness Pro System is not a medical device and is not intended to diagnose, treat, cure or prevent any disease.

I understand that Sun Seekers Tanning Ltd (“the facility”) intends to utilize the Cocoon Wellness Pro System to provide me with sauna (heat) and vibratory massage services for the promotion of relaxation, general wellness and fitness. I hereby give my consent to the facility and its staff to provide wellness services for these purposes. I further understand that members of the staff do not diagnose illness or disease or any other physical or mental disorder. I understand that sauna (heat) and vibratory massage therapies are not substitutes for medical examinations or treatments. I have been advised to consult with my personal physician for any ailments that I may be experiencing. I acknowledge that no assurance or guarantee has been provided to me as to the results of services provided by the facility. I hereby agree that the facility will not be liable for any injury to me resulting from my use of the Cocoon Wellness Pro System and I herby forever release the facility from any and all claims, demands, damages or causes of action resulting from said use.

Use of the Cocoon Wellness Pro System is not recommended for individual with the following conditions:

Individuals with the following conditions are advised to obtain physician consent before using the Cocoon Wellness Pro System

●       Epilepsy

●       Active Cancer

●       Broken bones or slipped disc

●       Infections/contagious skin conditions; skin lesions, abrasions and/or areas of inflammation/persistent erythema

●       Intoxication

●       Outfitted with pacemakers or defibrillators

●       Individuals running a fever or insensitive to heat (ie: erythema ab igne)

●       Pregnancy or lactating

●       Heart disease and/or cardiovascular conditions

●       Diabetes

●       Using medications such as diuretics, barbiturates, anticholinergics, and/or beta blockers

●       Hemophiliacs/Individuals prone to bleeding

●       Individuals with implants (metal, breast, etc)

●       In poor health

I understand that the staff must be made fully aware of existing medical conditions, if any. I also understand that prolonged exposure to heat can lead to dry skin. I have been advised that it is important to hydrate before and after heat sessions to insure against dehydration, and that for high heat sessions I should initially use a comfortable heat level and gradually increase the head level as my body acclimates or adjust to the higher cabinet temperatures.

The information I have provided is true and complete to the best of my knowledge. I have read this Informed Consent and Release Form and I have had the opportunity to ask questions about the contents and my treatment. By signing this Informed Consent and Release Form, I affirm my consent to treatment and intend this consent to cover the services discussed with me and such additional services as requested by me from time to time. I understand that at any time I may withdraw my consent and further services will be discontinued.

I HAVE READ, FULLY UNDERSTAND AND FULLY AGREE TO COMPLY WITH ALL OF THE ABOVE.

Today's Date: June 22, 2021

Thank-you for choosing Sun Seekers Tanning Salon for all your Tanning & Welness needs. Happy Tanning or PODing!

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First Clients Name

First Name*

Last Name*

Phone*
First Clients Date of Birth*
First Clients Information

Cell Phone # *

How did you hear about the salon? *

SKIN TYPE QUESTIONNAIRE

A. What is the natural color of your un-tanned skin?*
B. What is the natural hair color?*
C. What is your eye color?*
D. How Many freckles do you have naturally on your un-tanned body?*
E. What best describes your genetic heritage?*
F. Which best describes your sunburn potential?*
G. Which best describes your tanning potential?*
1. Have you ever been seriously sunburned?*
No
Yes

If Yes, how long ago?
2. Have you ever had an allergic reaction to sunlight?*
No
Yes

If yes, what type of reaction
3. Are you taking medication, which might cause you to be particularly sensitive to sunlight?*
No
Yes
4. Has your doctor recommend that you avoid sunlight or ultra-violet light?*
No
Yes
First Clients Signature*
Clients 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 or text.
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
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. Minors UV tanning under the age of 18 require a doctors note to tan as a provincial health regulation.
Parent or Guardian's Name

First Name*

Last Name*

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

Cell Phone # *

How did you hear about the salon? *

SKIN TYPE QUESTIONNAIRE

A. What is the natural color of your un-tanned skin?*
B. What is the natural hair color?*
C. What is your eye color?*
D. How Many freckles do you have naturally on your un-tanned body?*
E. What best describes your genetic heritage?*
F. Which best describes your sunburn potential?*
G. Which best describes your tanning potential?*
1. Have you ever been seriously sunburned?*
No
Yes

If Yes, how long ago?
2. Have you ever had an allergic reaction to sunlight?*
No
Yes

If yes, what type of reaction
3. Are you taking medication, which might cause you to be particularly sensitive to sunlight?*
No
Yes
4. Has your doctor recommend that you avoid sunlight or ultra-violet light?*
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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