koipondgirl

I had mine ready to go and then saw yours and combined parts of both. This is my final (atleast so far!!!) Of course it looks nicer in word. Let me know if your attorney recommends anything different with your cosent form.

Tan-Talizing Tans
Spray Tan Consent Form

Please complete, read, understand, and sign the following.

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:__________________

1. Spray tanning accomplished by application of a solution containing the active ingredient: DHA (Dihydroxyacetone). DHA is considered to be safe and has been FDA approved for cosmetic use. 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 external parts of the body and not to the lips or any body surface covered by mucous membrane" (21 CFR 70.3v).
2. DHA reacts with the skin’s amino acids resulting in a “tan” similar looking to that of the sun. The darker your skin, 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. Too much spray can result in an orange tint. Please follow the technician’s guidance on how she is going to spray.
3. You will enter a portable spray booth. What you wear is up to you and your level of comfort. It is recommended that you wear an old dark swimsuit or underwear. The solution should wash out of dark clothing; it is best to wash the swimsuit or clothing as soon as possible after your session.
4. Follow the staff’s breathing instructions as to avoid inhaling or ingesting the sunless product or use nose plugs provided by the technician. You will be prompted when to close your eyes while spraying or you may use the eye protection provided. A barrier crème will be applied to the lips.
5. You will then be airbrushed. This process will take approximately 5 to 10 minutes. Afterwards, your skin should be dry before putting your clothes back on. The solution will give you an immediate bronzing effect. The bronzing effect is a result of a coloring additive in the solution that will remain on the skin until your longer lasting tan develops. When you shower, the coloring will come off to reveal your actual tan beneath. I recommend showering 8 – 12 hours after the session, preferably letting the solution develop overnight. *Use dark sheets if going to bed before showering.
6. Following your session, avoid: wearing tight clothes and shoes, leather, perspiring, and water.
7. All people are different. All ingredients in the product 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. You may ask to see the ingredients prior to application.
8. Be advised we do NOT advise being sprayed for photographic sessions, modeling assignments, weddings, etc. unless you have had a trial spray tan with us within the last month.
9. Warning – This product does not contain a sunscreen and does not protect against sunburn. Repeated exposure of unprotected skin may increase the risk of skin aging, skin cancer and other harmful effects to the skin even if you do not burn.

This Process has been explained to me and I hereby agree to allow a technician of Tan-Talizing Tans, to apply the Spray Tan solution to my skin. To my knowledge, I have no medical condition or allergy which would preclude me from having this procedure done. I agree to hold Tan-Talizing Tans harmless of any and all medical complications that may arise. I have been advised to discontinue use if any reaction occurs.
I have read and fully understand this Client Release and Informed Consent Form and hereby agree to accept all of the provisions.

Client’s Printed Name: __________________________________ Date___________________

Signature: _________________________________Date: __________________

______ I opt out of wearing eye protection. ______ I opt out of wearing nasal protection.

Witness (Employee) Signature: ______________________ Date: ___________

I HEREBY GIVE MY PERMISSION as parent ( ) or guardian ( ) of _________________________________ who is ____ years of age (permission required if under 18), to be spray tanned by Tan-Talizing Tans.

SIGNED: ________________________________ Date: ___________________