Tanning Salon Release Form

Client Name

First NameLast Name

Client Date of Birth

Date

Client Email

example@example.com

Client Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Name (For 18 years old and below)

First NameLast Name

Parent/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

What is your skin type?

What is your skin color?

Other

Have you had any tanning within 6 months?

Do you have any allergies?

What type of allergies?

Are you Pregnant? or Breastfeeding?

Did you dye you hair within the last 3 months?

Do you have any respiratory ailment?

Do you have any cardiovascular ailment?

Do you have high-blood pressure or hypertension?

Have you had any surgery within 6 months?

Did you undergo any skin treatment inside a clinic before?

If yes, please tell us what kind of treatment and where did it happen or what is the name of the beauty clinic?

I understand the risk of indoor tanning to my skin and overall health. Wearing protective eyewear is a requirement.

I understand that the employees here are trained and skilled to do their tasks and I should comply with the Tanning Salons' policy and procedure. The company will require me to wear protective glasses during the procedure.

I hereby absolve the tanning salon of any liabilities, claims, any lawsuit from my side for I was forewarned of the risk of indoor tanning to my skin and overall health.

The company also affirmed the harmful effects of overexposure to ultraviolet radiation emitted by the tanning device may cause skin burns, premature skin aging, melanoma, and skin cancer.

Client Signature

Date Signed

Date

Tanning Salon Release Form

Consent