CLIENT HISTORY SHEET AND WAIVER

Name: _____________________________

Date of Birth: ________________________________

Address:____________________________________________________________

Phone #:________________________

Email: _________________________________________

Would you like to receive specials by email? YES NO

Do you have any skin conditions that may be of concern? YES NO
If yes, please explain: _____________________________________________________________

Are you pregnant? YES NO

Do you have any Allergies? YES NO
If yes, please list: __________________________________________________________________

Do you have Asthma or a Respiratory Condition? YES NO
If yes, please explain: _______________________________________________________________

Do you wear contact lenses? YES NO (Please remove prior to spray tan)

Are you under 16? YES NO
If yes, parent signature: _____________________________________________________________

Previous Use of Sunless Product (please circle):

Booth Spray Tan Tanning Technician Sunless Lotion Sunless Spray

Experience or reaction (if any): _______________________________________________________

Do you wish to have a skin test to check for any allergic reactions to any products prior to your
session or use? YES NO

I have been provided with pre, during, and post spray tan care instructions, which I have read and understand completely. All of my questions and concerns have been addressed. I understand that I am responsible for all jewelry, clothing and accessories that I wear before and after my airbrush tanning session in case of staining, loss, or damage. I understand that I do not hold anyone but myself responsible for any kind of color or allergic reaction that I might have to the formulas. I understand that I am doing this at my own risk. All information submitted is accurate.

I have read the above and all instructions provided to me and understand completely.

Print: ________________________________

Sign: ______________________________________

Date: _______________________

Tech Signature: _______________________________________