SKT SALON WAIVER

Please fill out the following medical waiver form

FLORIDA HEALTH requires us to obtain basic customer information that identifies the person and their age to ensure that services are used by individuals 16+

CLIENT RELEASE AND INFORMED CONSENT FORM

IF YOU DO NOT DEVELOP A TAN OUTDOORS, YOU ARE UNLIKEY TO TAN- FROM THE USE OF ANY TANNING DEVICE

AVOID OVEREXPOSURE. As with natural sunlight, overexposure can cause eye and skin injury and allergic reactions. Repeated Overexposure may cause photo aging of the skin, dryness, wrinkling and in some instances skin cancer. We recommend that you do not tan outdoors on days you are tanning indoors, that you do not tan if you currently have a sunburn and that you, at most, tan only once in a 24-hour period.

CERTAIN MEDICATIONS, Lotions and other Products may cause your skin to be more sensitive to UV Rays. Check the posted list of drugs and products known to increase the photosensitivity of the skin. Check with your physician or pharmacist if you are unsure about any medications, you are taking or if you have had a problem with indoor or outdoor tanning in the past.

Are you using any medication that may contain PSORALEN?

Yes

WEAR PROTECTIVE EYEWEAR. Failure to wear protective eyewear may result in severe bums or long-term injury to injuries to the eyes.

SUNLESS TANNING. The FDA recommends that you take the following measures to protect against ingestion or inhalation during your sunless session by using protective eyewear, nose filters, sealing lips with lip balm, and protective undergarments.

I have read the contents of this consent form carefully and state that I am not aware of any medical condition or other reason that would prohibit me from tanning. I understand that I will not be allowed to exceed the maximum allowable time posted on the tanning device. I have been given adequate instructions for the proper use of the tanning equipment, understand the risks involved, and use it at my own risk. I hereby agree to release the owners, operators and manufacturers from any damages that I might incur due to the use of this facility.

Your Signature