KSTAR

I have looked over some of the ones I found. I put together one that included what I thought was important in each. If there are any suggestions please let me know. I hope it helps someone else.

List any known allergies: ________________________________________ _____________
Are you allergic to latex? Yes or No
Are you presently pregnant? Yes or No
If yes, do you have a doctor’s permission to tan? Yes or No
Are you under a doctor’s care presently? Yes or No
If yes, please list the medical condition.______________________________ ___________
Have you ever been diagnosed with skin cancer? Yes or No

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 the CFR, "externally applied" cosmetics are those "applied only to ex-ternal parts of the body and not to the lips or any body surface covered by mucous membrane" (21 CFR 70.3v).

1. 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. Overexposure to DHA does not cause skin damage but can result in possible orange distortion of the skin. Like most cosmetics, avoid exposure to the eyes, lips, and other parts of the body covered with a mucous membrane this should be accomplished using a barrier cream. Follow the staff’s breathing instructions as to avoid inhaling or ingesting the sunless product.

2. Your spray tan should 5-10 days depending on your skin type and how well you take care of your sunless tan.
-Exfoliate with a non-oil exfoliator before getting sprayed
-Keep your skin moisturized after your spray tan, avoiding long baths or showers and hot tubs.
-Salt water exposure can also shorten your spray tan.

3. Following a spray tanning session please avoid: tight clothes, perspiring, leather seats, and do not shower for at least 8 hours. Letting the solution stay on overnight without showing is recommended.
-Too much spray can result in an orange tint. Please follow the technician’s guidance on how she is going to spray.

4. 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.

5. When you use the spray tan process you do not experience protection from the natural sun. Use sun-screen if you plan on going out in the sun. Always avoid overexposure to the natural sun.

6. In order to maintain your bronzed look you should use a tan extender daily and return within 10 days for another application.
I have read the contents of this consent form carefully and state that I am not aware of any medical condi-tion, 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.
Signature: _________________________________Date: __________________
Witness (Employee) Signature: ______________________ Date: ___________ **************************************** ********************************
For illiterate or visually handicapped persons, this release form has been read to the user in my presence. Witness: __________________________________ Date: _______________
**************************************** ********************************
I HEREBY GIVE MY PERMISSION as parent ( ) or guardian ( ) of _________________________________ who is ____ years of age (permission required if under 18), to sunless tan at this facility. I have read and fully understand this Client Release and Informed Consent Form and hereby agree to accept all of the provisions.
SIGNED: ________________________________ Date: ___________________