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UV TANNING DISCLOSURE, SAFETY ACKNOWLEDGMENT, ASSUMPTION OF RISK, AND RELEASE

Gray & Ko. Salon and Spa, LLC | 119 North Main Street, McPherson, Kansas | Customer Form 


1. Kansas Written Warning Statement

Kansas law requires the tanning facility to give each customer a written statement warning that:

Failure to use the eye protection provided to the customer by the tanning facility may result in damage to the eyes.



Overexposure to ultraviolet radiation causes burns.



Repeated exposure to ultraviolet radiation may result in premature aging of the skin and skin cancer.



Abnormal skin sensitivity or burning may be caused by reactions of ultraviolet radiation to certain foods, cosmetics, or medications, including tranquilizers, diuretics, antibiotics, high blood pressure medicines, or birth control pills.



Any person taking a prescription or over-the-counter drug should consult a physician before using a tanning device.



2. Additional Safety Disclosures

Please initial each statement:

I understand that ultraviolet radiation can cause serious skin and eye injury, allergic reactions, and cumulative damage, and that risk may increase with repeated or excessive exposure.


  

I understand that failure to use protective eyewear may result in severe burns or permanent eye injury. I will wear the protective eyewear provided by the Facility for the entire exposure period.


  

I will follow the manufacturer’s exposure schedule and the session time set by the trained operator. I will not tamper with the timer, controls, lamps, barriers, ventilation, or safety equipment.


  

I will not sunbathe immediately before or after exposure to ultraviolet radiation and understand that an indoor tan does not eliminate the risks of outdoor sun exposure.


  

I understand that a person who does not tan in the sun is unlikely to tan from an ultraviolet device or sunlamp.



  I understand that pregnancy or oral-contraceptive use combined with ultraviolet exposure may contribute to discolored skin, and I will consult a physician if I have questions.


  

I have informed the operator of any history of skin problems, unusual sensitivity to sunlight, recent tanning or sun exposure, burns, or other circumstances relevant to safe use.


I will immediately stop and alert the operator if I experience burning, pain, dizziness, eye discomfort, equipment malfunction, or any unexpected reaction. 


  

5. Facility and Session Rules

I agree to: (a) use only the assigned tanning device and session time; (b) use protective eyewear provided by the Facility; (c) follow directions from the trained operator and manufacturer; (d) use handrails, floor markings, and other physical aids as directed; (e) keep the room limited to one customer unless law or an emergency requires otherwise; (f) use only products approved for safe use with the equipment; and (g) avoid conduct that damages, contaminates, disables, or misuses the device.

I understand that the Facility may refuse or stop a session based on age, safety, health information, equipment condition, exposure history, law, or failure to follow instructions. Package, membership, cancellation, transfer, and refund terms are governed by separately disclosed written policies; no policy requires the Facility to provide an unsafe or unlawful session.


6. Voluntary Participation and Assumption of Risk

I voluntarily choose to use a device that emits ultraviolet radiation. I understand and knowingly assume the ordinary and inherent risks of tanning, including burns, eye injury, skin irritation, allergic or photosensitive reactions, premature skin aging, pigment changes, and increased risk of skin cancer, together with risks caused by my inaccurate disclosures or failure to follow instructions.

I understand that compliance with safety instructions reduces but does not eliminate risk. I may decline or stop a session at any time and may consult a physician before deciding whether to tan.


7. Release and Covenant Not to Sue

To the fullest extent permitted by Kansas law, I release and agree not to sue Gray & Ko. Salon and Spa, LLC and its members, managers, employees, trained operators, and agents (collectively, the “Released Parties”) for claims for personal injury or property loss arising from the ordinary negligence of a Released Party in connection with my voluntary use of the tanning facility or device.

This release does not apply to gross negligence, reckless or willful misconduct, fraud, a violation of law that cannot be waived, or any other liability Kansas law prohibits from being released. It does not excuse the Facility from statutory duties concerning minors, warnings, trained operators, eyewear, timers, exposure limits, temperature, licensure, or other nonwaivable requirements.


8. Personal Property; Emergency Assistance

I remain responsible for personal property brought to the Facility. The Facility is not responsible for loss or theft except to the extent liability cannot lawfully be disclaimed. In an apparent emergency, I authorize the Facility to contact emergency services, and I remain responsible for resulting charges.


9. Acknowledgment and Signature

I certify that my information is accurate and that I am at least 18 years old. I have read the written warnings and this Agreement, understand them, had an opportunity to ask questions and consult a physician or attorney, and voluntarily agree to comply with all safety instructions. I understand this form does not replace the warning signs and equipment instructions posted at the Facility. 


Today's Date: October 14, 2026

Please select who will be participating...
AdultMinor
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First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Information
Are you under 18 years of age? *
No
Yes
Are you currently sunburned, or have you tanned or sunbathed within the interval prohibited by the manufacturer’s exposure schedule or Facility policy? *
No
Yes
Are you taking any prescription or over-the-counter medication, supplement, topical product, or cosmetic that may increase sensitivity to ultraviolet radiation? *
No
Yes
Do you have a history of skin cancer, suspicious or undiagnosed skin lesions, severe sunburn, unusual photosensitivity, or a condition for which a physician has advised avoiding ultraviolet exposure? *
No
Yes
Are you pregnant, using oral contraceptives, or concerned about pigment changes or another health issue associated with tanning? *
No
Yes
Have you experienced an adverse reaction during or after a prior tanning session? *
No
Yes
First Participant's Signature*
Parent or Guardian's Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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*
Date of Birth
Information
Are you under 18 years of age? *
No
Yes
Are you currently sunburned, or have you tanned or sunbathed within the interval prohibited by the manufacturer’s exposure schedule or Facility policy? *
No
Yes
Are you taking any prescription or over-the-counter medication, supplement, topical product, or cosmetic that may increase sensitivity to ultraviolet radiation? *
No
Yes
Do you have a history of skin cancer, suspicious or undiagnosed skin lesions, severe sunburn, unusual photosensitivity, or a condition for which a physician has advised avoiding ultraviolet exposure? *
No
Yes
Are you pregnant, using oral contraceptives, or concerned about pigment changes or another health issue associated with tanning? *
No
Yes
Have you experienced an adverse reaction during or after a prior tanning session? *
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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