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CLIENT RELEASE AND INFORMED CONSENT FORM FOR:

UV TANNING

RED LIGHT THERAPY

SUNLESS TANNING

COCOON WELLNESS POD

 

CLIENT RELEASE AND INFORMED CONSENT FORM

PLEASE NOTE: For your protection none of your Information will be distributed.

For all medical related inquires regarding the use of The Tanning Studio facilities, please consult your doctor.

Please Read and Answer Carefully

Cocoon

It is important that you inform our staff if you have any of the conditions listed below under “contraindications for use of the Cocoon Fitness Pod System” before undertaking sauna (heat) and/or vibratory massage treatments. The Cocoon Fitness Pod System is not a medical device and its is not intended to diagnose, treat, cure or prevent any disease.

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.

I understand that BEARETAN LTD. DBA THE TANNING STUDIO (“the facility”) intends to utilize the Cocoon Fitness Pod 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 Fitness Pod System and I herby forever release the facility from all claims, demands, damages, or causes of action resulting from said use. 

Contraindications for use of the Cocoon Fitness Pod System: 

Use of the Cocoon Fitness Pod System is not recommended for individual with the following conditions:

  • 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 abigne)


Individuals with the following conditions are advised to obtain physician consent before using the Cocoon Fitness Pod System

  • 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.

 

Sunless

You have agreed to participate in a series of Sunless Inc. sessions to achieve a tan on your skin. To help you best achieve your desired results, please read the following material carefully.

  1. A Sunless Inc. session will not prevent your skin from burning in the natural sun or in a tanning bed, like a base tan will. Please take the proper precautions when tanning with UV light exposure.
  2. Maintaining your color is possible with subsequent visits of every 5-7 days. Healthy, hydrated skin will hold results longer and achieve color faster. Existing or underlying skin conditions may alter the results of the Sunless Inc. session. Ask a tanning consultant for a recommendation of the proper regimen.
  3. For best results, wait 8-12 hours after using the Sunless Inc. booth before showering or engaging in any activity that will cause you to perspire. This will allow your Sunless Inc. session to fully develop and will ensure the longest results.
  4. The Sunless Inc. booth is designed to provide as even a tan as possible. However, tanners will be different heights and shapes, and may stand in different positions. It is possible you will find some areas of your tan lighter than others. In most cases, these differences are minor and disappear after several sessions.
  5. More than one Sunless Inc. session per 24 hours is not recommended.
  6. Because of the moisturizing agents in the mist, your eyes may feel itchy or scratchy but there is no evidence that the mist that will cause them any harm.
  7. All the components of the Sunless Inc. tanning solution have been used in cosmetics and food products for decades and have proven to be safe for the skin. If you have ever had any adverse effects utilizing self-tanning products or moisturizers you will probably experience similar effects with Sunless Inc.
  8. All the active ingredients in the Sunless Inc. Solution are FDA approved for use as a self-tanning skin agent. However, the FDA has not specifically tested the ingredients for use in a spray on mist application. Thus, the spray-on tanning process with this solution is not FDA approved. Testing of the ingredients for this application is currently in progress, and results to-date indicate that there are no adverse effects due to inhalation or contact with human mucus membranes, such as eyes or inside the nose or mouth or any part of the body covered by mucus membranes. In the meantime, we recommend taking protective measures and if a user chooses, he or she can request protective covering devices from the Sunless Inc. operator.
  9. If you choose not to use the recommended inhalation protection, we recommend that you hold your breath during the actual misting process, which lasts approximately 8 seconds per cycle. We make this recommendation because most individuals would prefer not to breathe in the mist even though there is nothing in it that would cause any harm if you did breathe it.
  10. Use of personal garments should be of the disposable kind as the DHA in Sunless Inc. solution may permanently stain them. After towelling off and redressing, the initial bronzers may transfer to your clothing if you pursue strenuous physical activity causing perspiration. Since the bronzers are water soluble, they will wash out.
  11. Many customers wear disposable shower caps (provided by the salon) to keep the solution from getting in their hair. Others tan without covering their hair. The solution cannot penetrate hair follicles and there have never been any cases where the tanning solution has changed anyone's hair color.
  12. If you have any history of asthma or respiratory condition that could be aggravated by using the Sunless Inc. booth, please consult a physician before using it and be sure to apprise us of any past allergic reactions to DHA products.
  13. Some of the ingredients used in our solution contain a sugar base. Use of the machine may cause your blood sugar levels to rise. Please consult with a physician before using Sunless Inc. booth if you have a diabetic condition.
  14. I, the undersigned, understand and will comply with all instructions for proper use of the Sunless Inc. unit. I am using these services at my own risk. I hereby relieve Bearetan Ltd. dba The Tanning Studio of any responsibility to reimburse me if deemed that I had failed to follow the instructions of the Sunless Inc. unit which in turn could lead to alter the results of my Sunless Inc. session. I hereby authorize and direct employees or agents of the salon to perform such tanning procedures as may be deemed necessary or advisable and have provided them with the above information required. I hereby relieve Bearetan Ltd. dba The Tanning Studio and hold them harmless from any liability involved in the use of the tanning process. The salons and their agents or employees are not liable for any injury to person or property or the loss or theft of any personal property. I know that this facility does not carry liability insurance for injuries caused by tanning devices. I will not tamper with the tanning device. I have been made aware that the salon reserves the right to cancel package without reimbursement for customers who are verbally abusive, act in an inappropriate behaviour, do not adhere to the salon rules, and/or act in a destructive or harmful manner. I understand that packages are sold on a per person basis and are not sharable or transferable.
  15. ALL SALES ARE FINAL. I have read the above conditions and information on the Sunless Inc. booth.

 

Tanning/Red Light

Applicants under the age of 18 are legally not permitted to use UV tanning and/or Red Light equipment. Consent to the use of BeareTan Ltd. dba The Tanning Studio, the tanning facilities is conditional upon provision of accurate answers to the following questions and signing of the Waiver of Liability.

Your session times are determined according to your skin type, tanning history as well as the condition of our tanning lamps and not by the maximum exposure times of the tanning units. We realize that you may have been tanning elsewhere, but we know our equipment the best; please follow our advice. Failure to follow said advice may result in burning for which we cannot be held responsible.

Red Light Therapy session time is 12 minutes maximum and 1 session per day. Recommended exposure schedule is a minimum 3 sessions per week for 3 months. After the initial 3 months, the maintenance schedule is 1-2 sessions per week. Results may very.

To accurately compile client histories each person wishing to tan must sign a Waiver and be entered into our computer program. We promote responsible tanning and do not allow double sessions or tanning more than once per day.

Please try to be on time for your appointments; we may not be able to honour your appointment if you are late.

Mineral oil, baby oil, outdoor tanning oils, and lotions, etc. are harmful to the tanning bed acrylics. Please do not use any lotion that is not intended for indoor use and/or that has not been approved by one of our staff. Using these items may result in the loss of your points/package without notice.

Cleanliness is PARTICULARLY important to us. We sanitize the room door handles, the chair, the music volume knob, the handles and controls on the beds, the top and bottom acrylics, and the pillow after every session.

We do not supply eye protection for health and sanitary purposes. You are required to wear eye protection for every Tanning & Red Light session. Your eyelids are only .04mm thick and UV rays can penetrate up to 2mm deep. Do not tan or read light without approved eyewear. Notify our staff if you do not have personal protective eyewear. Never remove your eyewear when the tanning equipment is on.

Our staff are Smart Tan Certified, and we strive to ensure that you receive the safest and most comfortable tanning experience possible.

We will assist you in obtaining your desired level of tan with our tanning knowledge and experience. The Tanning Studio will also be able to assist with choosing the lotion best suited for your skin type and tanning objectives.

We are not liable for the loss of any personal property. Each person is responsible for his or her own property.

We and our employees reserve the right to refuse service to any customer that appears to be under the influence of any alcohol or drugs. Anyone appearing to be under the influence will be asked to leave the premises.

We are not responsible for children left unattended. Anyone under the age of 18 must have an adult with them.

There is only one person allowed per room.

There is absolutely zero tolerance for verbal abuse or harassment towards other clients and staff members. Result of such actions will be immediate termination of package and account without refund. You will also be banned from the premises.

No persons may enter the premises: experiencing symptoms of Covid-19, having had contact with a person experiencing symptoms of Covid-19, or leaving the country within the last 14 days.

No open food or drink are allowed in the salon at this time.

Clients using services may not bring guests to wait in the salon at this time.

Only 2 clients can be in the lobby at one time. Everyone else will be asked to wait outside.

Masks are Mandatory in all common areas of The Tanning Studio. 

Appointments are not mandatory currently but are HIGHLY recommended.

Appointments will be kept for clients till 5 minutes after schedule start time. If client is not here, the next client waiting will be processed.

Clients are asked to please start equipment promptly as well as exit the room shortly after your session. This will allow ample time for staff to sanitize the room for the next client and to keep appointments on time and running smoothly.

Failure to arrive on time and/or enter and exit room promptly may result in a lowered session time.

Headphones must be used to listen to your own personal music, podcasts, etc.

Any appointment booking changes and/or cancellations must give a minimum of 3 hrs notice. Without proper notice and/or if a client no shows 3 times, they will be suspended from booking appointments and will have to do drop ins.

Parking in Edgewater Center "Do Not Park" spots, may result in being towed or ticketed by the Building Management. *Please know we have no control over this*

 

PLEASE READ THE FOLLOWING INFORMATION AND ACKNOWLEDGE THAT YOU UNDERSTAND AND ACCEPT ALL PROVISIONS BY SIGNING BELOW. WE RESERVE THE RIGHT TO REFUSE SERVICE TO ANYONE AT ANY TIME.

It is our intention to keep you as well informed about tanning as possible. This means informing you how to operate the tanning equipment. The proper procedure to following in the tanning room will be clearly explained by a member of our staff. We recommend sensible, moderate, and responsible exposure to Ultraviolet Radiation (UVR). If you do not develop a tan outdoors, you are unlikely to tan from the use of any tanning device. Overexposure can cause Erythema (sunburn). Please feel free to ask ANY questions.

1.      AVOID OVEREXPOSURE
As wit h natural sunlight, overexposure can cause eye and skin injury and allergic reactions. Repeated overexposure may cause photo aging of the skin, dryness, wrinkling and in some instance skin cancer. We recommend that you do not tan outdoors on days you are tanning indoors, that you do not tan if you currently have a sunburn and that you, at most, tan only once in a 24-hour period.

2.      CERTAIN MEDICATION
Lotion and other products may cause your skin to be more sensitive to UV Rays. Check the posted list of drugs and products known to increase the photosensitivity of the skin. Check with your physician or pharmacist if you are unsure about any medications you are taking or if you have had a problem with indoor or outdoor tanning in the past.

3.      WEAR PROTECTIVE EYEWEAR
You are required to wear protective eyewear while using UV Tanning or Red Light Therapy equipment in our facility. Failure to wear protective eyewear may result in severe burns or long-term injury to the eye. We recommend that you remove contact lenses before tanning.

I have read the contents of this consent form carefully and state that I am not aware of any medical condition or other reason that would prohibit me from tanning. I understand that I will not be allowed to exceed the maximum recommended tanning time by certified staff. I have been given a tour and adequate instructions for the proper use of the tanning equipment, understand the risks involved, and use it at my own risk. I hereby agree to release the owners, operators and manufacturers from any injury or damages that I might incur due to the use of this facility.

The client declares that he or she is 18 years of age or older and is competent to sign this release. Client Signature:

Date Signed: August 10, 2022

 

SKIN TYPE ANALYSIS

The Golden Rule of Smart Tanning is simple: Don't EVER sunburn. The Tanning Studio is a professional indoor tanning facility and is dedicated to helping you avoid sunburn whether you tan indoors with us and/or outdoors. Helping you understand how much sun your skin type can handle is an important step in your life-long skin care regime.

Moderate sun exposure for individuals who can develop a tan is the smartest way to maximize the real benefits of sunlight while minimizing the risks of too much or too little sun exposure. In keeping with our policy of Smart Indoor Tanning, new clients will be asked to answer the following Skin Type Analysis questions before using any equipment on their first visit.

 

First Clients Name

First Name*

Last Name*

Phone*
First Clients Date of Birth*
First Clients Information
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

First Clients Signature*
Second Clients Name

First Name*

Last Name*
Second Clients Date of Birth*
Second Clients Information
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

Third Clients Name

First Name*

Last Name*
Third Clients Date of Birth*
Third Clients Information
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

Fourth Clients Name

First Name*

Last Name*
Fourth Clients Date of Birth*
Fourth Clients Information
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

Fifth Clients Name

First Name*

Last Name*
Fifth Clients Date of Birth*
Fifth Clients Information
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

Sixth Clients Name

First Name*

Last Name*
Sixth Clients Date of Birth*
Sixth Clients Information
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

Seventh Clients Name

First Name*

Last Name*
Seventh Clients Date of Birth*
Seventh Clients Information
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

Eighth Clients Name

First Name*

Last Name*
Eighth Clients Date of Birth*
Eighth Clients Information
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

Ninth Clients Name

First Name*

Last Name*
Ninth Clients Date of Birth*
Ninth Clients Information
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

Tenth Clients Name

First Name*

Last Name*
Tenth Clients Date of Birth*
Tenth Clients Information
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Communication Preferences:
Check the box on what communication form you prefer. *Please note: Emails and Texts are sent out 1-2 times per month (we do not sell information or spam you)
Email
Text
Both
None
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
1. How did you hear about The Tanning Studio? *
Word of Mouth
Signs
Walk / Drive-by
Google
Facebook
Instagram
Referral

Referral (full name)
2. Have you tanned in the last 30 days?*
No
Yes
3. Do you tan easily?*
No
Yes
4. Do you go regularly into the sun?*
No
Yes
5. Do you have a tendency to burn?*
No
Yes
6. Do you have any know allergies to sunlight?*
No
Yes
7. Have you ever suffered from a major sunburn?*
No
Yes
8. Have you ever been advised by a physician to stay out of the sun?*
No
Yes

If yes, for what reason:
9. Are you taking any medication that could cause photosensitivity?*
No
Yes

If yes, please list
11. Are you pregnant or suspect that you may be pregnant?*
No
Yes
12. Have you ever received medical treatment for a diagnosis of skin cancer?*
No
Yes

If yes, please list details:

SKIN TYPE ANALYSIS

1. What is the natural color of your skin?*
2. What is your natural hair color?*
3. What is your eye color?*
4. How many freckles do you naturally have on your untanned body?*
5. Which best describes your genetic heritage?*
6. Which best describes your SUNBURN potential?*
7. Which best describes your TANNING potential?*

Submit this form to our staff to tally your points and determine your skin type. Your skin type is determined by matching your total score to the skin type chart below.


Total Score:

Skin Type:

SKIN TYPE CHART

0-7 SKIN TYPE I - Very sensitive to sunlight.
8-21 SKIN TYPE II - Sensative to sunlight.
22-42 SKIN TYPE III - Normal sensitivity to sunlight.
43-64 SKIN TYPE IV - Skin is tolerant to sunlight.
65-84 SKIN TYPE V - Skin is brown. Very tolerant.
85+ SKIN TYPE VI - Skin is black. Extreme tolerance.

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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