Tanning Salon Form

Name: D.O.B: Address: City: State: Phone: Email:

Precautions and Agreement

A. A person who uses a tanning device in this facility must use eye protection.

B. If the provided eye protection is not worn, use of a tanning device may cause damage to the eyes.

C. Overexposure to ultraviolet radiation produced by the tanning devices may cause skin cancer.

D. Repeated exposure to ultraviolet radiation produced by the tanning devices may cause skin cancer.

E. Abnormal skin sensitivity to ultraviolet radiation or burning may be caused by certain foods, cosmetics and medication including but not limited to the following:

Tranquilizers
Diuretics
Antibiotics / anti-inflammatory
Birth control medicines
Other photosensitizing agents

F. An individual who is taking prescription drugs or over-the-counter drugs should consult a physician before using a tanning device.

G. A person who is less than eighteen (18) years of age shall be able to use a tanning device with a written order from a physician licensed under RSA-329.

I agree that I will comply with all instructions on the use of the UV system and that I am using these services at my own risk.

I agree to hold harmless FOREVER TAN TANNING SALON and its employees and agents of any injury to the person of property in a way by the use of its premises and services.

In addition, they are not liable for the loss or theft of any personal property. Each person is responsible in safeguarding his or her own personal property.

I agree to the terms and conditions

Describe your eye and skin type

Natural Eye Color: Light blue, gray, green Blue, gray, green Blue Dark brown Brownish black

Natural Hair Color: Sandy red Blonde Chestnut or dark blonde Dark brown Black

Untanned Skin Color: Reddish Very pale Pale with beige tint Light brown Dark brown

Freckles: Many Several Some Few None

Determination based on tanning history

What happens when you stay in the sun too long? Painful, redness, peeling, blistering Burn regularly with peeling Burn sometimes with peeling Rarely burn Never burn

To what degree do you tan? Hardly not at all Tan little or lightly Tan moderately Tan very easily Quickly turn dark brown

Do you turn brown immediately after tanning? Never Hardly Sometimes Often Always

How does your face react to the sun in regard to burning? Very sensitive Sensitive Normal Barely sensitive Never a problem

Signature

By typing your name below, you agree that this constitutes your electronic signature.

Typed Signature:

Forever Tan Consent Form

Precautions and Agreement

Describe your eye and skin type

Determination based on tanning history

Signature