Fill and Sign the Tanning Waiver Form

Tanning Release Form including Waiver and Release by Legal Guardian or Parent Name of Customer: ______________________________________________________ Date: _____________________ Address: _______________________________________________ City: __________________________ State: ______________________ Zip: ____________ Home Phone: ____________________ Business Phone: _________________________ Date of Birth: _________________ E-mail Address: ______________________________ Please read the following and sign at the bottom where indicated in you agree. 1. Using a Tanning Device. A. A person who uses a tanning device in this tanning facility must use eye protection. B. If eye protection is not worn, use of a tanning device in this facility may cause damage to the eyes . C. Overexposure to the ultraviolet radiation produced by a tanning device in this facility may cause burns. A painful, blistering sunburn prior to the age of eighteen can significantly increase the risk of skin cancer/melanoma. D. Repeated exposure to the ultraviolet radiation produced by the tanning devices in this tanning facility may cause premature aging of the skin, skin thickening, and skin cancer. E. Abnormal skin sensitivity to ultraviolet radiation or burning may be caused by certain foods, cosmetics, or medication, including, but not limited to, the following: 1. Tranquilizers; 2. Diuretics; 3. Antibiotics; 4. High blood pressure medication; 5. Birth control medication; and 6. Other photosensitizing agents F. An individual who is taking a prescription drug or over-the-counter drug should consult a physician before using a tanning device. G. A person who is less than Sixteen (16) years of age must be accompanied by a parent or guardian when using a tanning device in this facility. H. A person who is less than Eighteen (18) years of age may not use a tanning device in this facility unless the parent or guardian has also signed this written tanning release form. The form must be signed in the presence of the operator of the facility. I. Different skin types respond differently to tanning. J. Tanning may be inadvisable during pregnancy and for persons with photosensitizing disease, melanoma or other skin cancers. Tanning may cause possible activation of some viral conditions (cold sores) etc. 2. I agree that I will comply with all instructions on the use of the UV 1 system and that I am using these services at my own risk. 3. I agree to hold harmless all Executive Tans and affiliates, its employees and agents for any injury to person or property in any 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 for safeguarding his or her own property. 4. Purchaser agrees to use all sessions within the terms of the contract dates and understands that refunds are never given on unused portions of tanning packages for any reason. 5. I understand that it is against policy to tan in more than one indoor tanning salon in one day. 6. Waiver, Release and Consent A. Having been advised and fully informed by _______________________ (Name of Business) , hereinafter called the Facility , concerning the nature of the sun tanning process proposed to be administered including the effects of such process and the possible risks and consequences of exposure to the indoor sun tanning equipment used in such process, I hereby authorize and direct them to administer such indoor tanning process and perform such indoor tanning procedures as may be deemed necessary or advisable. I hereby confirm that no warranty or guarantee, or other assurance, has been made to me covering the results of the indoor sun tanning process. I fully understand the administration of the indoor sun tanning process, including possible adverse skin reaction, side effects, or other possible complications. It is understood that this Waiver, Release and Consent is being given in advance of any administration of the process, and is being given by me voluntarily to induce Facility 2 to exercise their best judgment as to the manner and requirement of administering the sun tanning process, and procedures to me. B. My signature below constitutes my acknowledgment that: 1. I have read, understand, and fully agree to the foregoing Waiver, Release and Consent , 2. The proposed indoor sun tanning process has been satisfactorily explained to me and I have all of the information I desire and 3. I hereby give my authorization and consent which shall continue in effect as long as I tan with any Facility location now and in the future. I have read the instructions for proper use of the tanning facilities and shall use such tanning facilities at my own risk. For and in consideration of said being allowed to use the facilities of __________________________ (Name of Business) , I hereby release 1 Ultraviolet Light 2 The term “Facility” shall include the business operated in the Facility, the owner, officers, directors, and/or employees of the Facility __________________ (Name of Business) , its directors, officers, and employees (collectively “Releasees”) from all liability to me for any loss or damage to property or injury or death to me whether caused by Releasees or otherwise that result, directly or indirectly from the use by me of the tanning facilities of _________________________ (Name of Business). I further agree to indemnify, save and hold Releasees harmless from any loss, liability, attorneys’ fees, damage, or costs that they (or any of them) may incur arising out of or related to the use by me of the tanning facilities of _________________________ (Name of Business) , whether caused by the negligence of the Releasees or otherwise. Witness my signature this the _____ day of ________________, 20______. ____________________________ (Signature of Customer) ____________________________ (Printed Name of Customer) ____________________________ (Witness to Signature of Customer) Waiver and Release by Legal Guardian or Parent I hereby represent that I am the parent or legal guardian of the above mentioned Minor Customer (who is under the age of 18 years) and am authorized to execute this Release. I do further agree and represent that: A. Client is physically able to safely use said tanning facilities; B. I have thoroughly read this document and fully agree to its terms. C. I have inspected the tanning facilities and equipment and accept them as being safe and reasonably suited for the purposes intended; and D. I voluntarily signed this Waiver and Release. For and in consideration of said Minor being allowed to use the facilities of Company, I, on behalf of myself and said Minor Customer , release ________________________ (Name of Business), its directors, officers, and employees (collectively “Releasees”) from all liability to me or Minor Customer for any loss or damage to property or injury or death to Minor Customer whether caused by Releasees or otherwise that result, directly or indirectly from the use by Minor Customer of said tanning facilities operated by ____________________________ (Name of Business) . I further agree to indemnify, save and hold Releasees harmless from any loss, liability, attorneys’ fees, damage, or costs that they (or any of them) may incur arising out of or related to the use of said tanning facilities by Minor Client whether caused by the negligence of the Releasees or otherwise. Witness my signature this the _____ day of _____________, 20______. ____________________________ (Name of Minor Client) By: ___________________________ ____________________________________ (Signature of Parent or Guardian) (Signature of Parent or Guardian Individually) ______________________________ ____________________________________ (Printed Name of Parent or Guardian) (Printed Name of Parent or Guardian) _________________________ _________________________ (Witness to Signatures) (Witness to Signatures)