Phone : (1 req'd for
follow-up correspondence)
(home)____________(cell)__________(email)__________
Referred by: _________________
(Please Circle)
- Have you ever been Airbrush Tanned? Y / N
- Do you have known allergies related to Dihydroxyacteone (DHA)? Y / N
- Do you have eczema or psoriasis? Y / N
- Do you have asthma or any other respiratory condition Y / N
- Are you or could you be pregnant? Y / N
We do not spray women who are in the first trimester for safety reasons. If you
are beyond the first trimester or nursing, written permission must be obtained
from your doctor before being airbrush tanned.
* If under the age of
16
years, you must have a parent or guardian's consent before being airbrush
tanned.
Signature of parent /
guardian:
I, _________________ give my consent for the above client to be airbrush
tanned without my presence at time of session. I have read and understand all
aspects of this form.
I, the undersigned
agree to and understand the following:
· I have understood all of the instructions & procedure details given to me
prior to the session.
· I have been offered disposable garments and a facemask.
· I understand that I am responsible for all jewelry, clothing, accessories I
wear before & after my tanning session in case of staining or damage.
· While allergic reaction is rare, I assume responsibility for any kind of
allergic reaction I may have and will seek immediate medical attention and
absolve the airbrush technician of any liability for the application of the DHA
sunless tanning product.
· While the DHA bronzing residue will appear darker after four to six hours the
client understands that majority of this will " wash off " with their
after tan shower leaving a natural looking tan.
· I understand that DHA has been FDA approved for sunless tanning for over
thirty years.
· I understand that I am doing this at my own risk.
