Loading...

Release Waiver

Please read, understand, and sign the following:

Spray 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 or misting:  

  • Are you protected from exposure in the entire area of the eyes, in addition to the eyes themselves? (Goggles or stickers can be requested if needed) 
  • Are you protected from exposure on the lips and all parts of the body covered by mucous membrane? (Lip balm or sticky garments are available if requested) 
  • Are you protected from internal exposure caused by inhaling or ingesting the product? (Ventilation used as needed, and nose filters are available upon request) 

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.  

An airbrush tan will not protect your skin from burning in the natural sun or in a UV tanning bed. Healthy, hydrated skin will hold results longer. Wait at the least 8-10 hours after your spray tanning session before showering. I recommend showering 8-10 hours after the session, preferably letting the solution develop overnight. *Use dark sheets if going to bed before showering. The initial bronzers in the spray tanning solution may transfer to clothing or fabric. The bronzers are water-soluble and will wash out of most fabrics.

All the components of the spray tanning solution have been safely used in cosmetics and nutritional products for decades and have been proven safe for the skin. If you had adverse affects utilizing self-tanning products or moisturizers in the past, you may experience similar effects with the airbrush tanning.

There are, however, occasions where individuals may be allergic to one or more ingredients in the spray

Tan solution. Please discuss this with the technician before proceeding.

We recommend that you hold your breath and close your eyes during facial spraying. We make this

recommendation because most individuals would prefer not to breathe the mist. The FDA recommends that you use Nose filters, lip protection, protective undergarments and are available upon request. The solutions aren’t considered harmful in the minimal amounts that may be inhaled in a normal spray tanning session. The bronzing effect is a result of a coloring additive in the solution that will remain on the skin until you shower. When you bathe, the initial bronzer will wash off leaving your skin with a natural looking tan.

This process has been explained to me and I hereby agree to allow PearlTan Co’s technician, to apply the spray tan solution to my skin. I have been given adequate instructions for the proper use of the sunless application, understands the risks involved, and use it at my own risk. I agree to hold PearlTan Co harmless of any and all medical complications that may arise. I have been advised to discontinue use if any reaction occurs.

I hereby agree to release PearlTan Co owners, spray technicians, contractors and manufacturers from any or all damages that I might incur due to the use of PearlTan Co’s services and products.

 

I, the undersigned understand and agree to comply with all instructions. I have been properly instructed prior to my airbrush session. I am using these services at my own risk. I hereby authorize and direct employees of PearlTan Co to perform such tanning procedures as may be deemed necessary or advisable, and I have provided them with the above correct information required.

 

I acknowledge that the results of airbrush tanning do vary and that no guarantees of specific results are offered or implied. By signing this waiver, PearlTan Co and their employees/contractors are not held liable for any injury to persons or property and hold them harmless from any liability involved in the use of the tanning process.

I release and discharge PearlTan Co from all manners of actions, judgments, sums of money and demands whatsoever in law, in regards to spray tanning. I have been advised that the wear of spray tanning depends upon my skins age, texture and absorbency ability and the after care that is given. I affirm that I have been advised of the spray procedures and that the products being used are FDA approved and give my permission to proceed with the spray application. I have been advised to discontinue use if any reaction occurs. I am not allergic to any dyes, inks or cosmetics to my knowledge, and if I am I will discuss these concerns with my doctor and my spray technician before I receive a spray tan.

All information provided is confidential information only for the purpose of PearlTan Co and will not be shared or made public.

We reserve the right to refuse service to anyone.

All people, all skin, is different. All ingredients used in this procedure 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 spray tan solution. Please read the ingredients list if you have any known allergies. Please discuss with your technician. 

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/prom) please schedule a practice session 30 days before your event, for best results. 

• Common Sense Caution – Pregnant or nursing women should consult their physician, and obtain a written release before using. Spray 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. 

• 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 of any reaction I may have, staining of clothing and/or personal belongings.  

I have read and completely understand this consent form. (Please advise your technician if you have any questions)

Date: October 16, 2021

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
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*
Would you like to be added to our e-mail list for client discounts?
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*
Parent or Guardian's Information
What tan are you purchasing today?*
For those choosing the Rapid Tan (2 - 4) please circle what color you want?
Have you received a spray tan or applied a self tanner (lotion) before?*
No
Yes

List any known allergies:
Any related to spray tans or sunless tanning products with Dihydroxyacetone (DHA)?*
No
Yes

Those whom have allergies are asked to look at the ingredients list of the spray tan to insure that there is no cause of concern before proceeding with the spray tan process. There may be some people who are allergic to the base ingredients in the spray solution, which may result in hives or a skin rash. If this occurs, shower and discontinue use. If severe reaction, contact a physician.

Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
Please select your skin type: (may choose more than one)
Type 1 Never tans/Always burns
Type 2 Light tan/Burns easily
Type 3 Does tan/Can burn
Type 4 Easily tans/Rarely burns
Type 5 Dark tan/Rarely burns
Type 6 Dark tan/Never burns
Very Oily
Normal
Dry
Very Dry
Oily
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!