Comply with the instructions on the use of the tanning system while signing the tan waiver online.

Membership Form

Please fill your name: *

Please enter your full name.

Phone number: * Please enter your phone number.

Email: * Please enter your email.

Please fill in Address: *

Please enter address.

Date of Birth: *

Please enter valid date.

The following questions are necessary so that we may better serve you. Each question MUST be answered HONESTLY.

Do you tan easily? *

Yes

No

Please select at least one choice above.

Do you regularly go into the sun? *

Yes

No

Please select at least one choice above.

Do you have a tendency to burn? *

Yes

No

Please select at least one choice above.

Do you have any known allegies to sunlight? *

Yes

No

Please select at least one choice above.

Have you ever suffered a major sunburn? *

Yes

No

Please select at least one choice above.

Have you ever been advised by a physician to stay our of the sun? *

Yes

No

Please select at least one choice above.

If so, what was the reason? Please enter your answer here.

Are you taking any medication that could cause sensitivity to sunlight? (Please review list below) *

Yes

No

Please select at least one choice above.

Antimicrobial Agents Other Drugs

Tetracyclines, espec. Demeolocycline Phenothiazines, espec. Chiorpromazine

Sulfonamides, espec. Sulfanilamide Thiazides

Griseofulvin Psoralens

Halogenated salicylanilides Sulfonylureas

Others

Oral Contraceptives, Sunscreens, Tar.

Cosmetics (due to presence of eosin, psoralens, or antimicrobial agents)

***************DANGER - ULTRAVIOLET RADIATION***************

1. Follow Instructions
2. Avoid overexposure. As with natural sunlight, exposure can cause eye and skin injury and allergic reactions. Repeated exposure may cause aging of the skin, dryness, wrinkling and skin cancer.
3. Wear eye protection

FAILURE TO USE PROTECTIVE EYE WEAR MAY RESULT IN SEVERE BURNS OR
LONG-TERM INJURY TO THE EYES.

4. Medications or cosmetics may increase your sensitivity to the ultraviolet radiation. Consult a physician before using a sunlamp if you are using medications or have a history of skin problems or believe you are especially sensitive to sunlight.
5. If you do not tan in the sun, you are unlikely to tan from use of this device.

Precautions are necessary for safe tanning. I agree that i will comply with ALL instructions on the use of the UVA tanning system, and that I am using these services at my own risk, and protecting my vision by using the goggles provided.

We, and our employees and agents, are not liable for any injury to person or property caused in any way by the use of its services or its premises. Also, they are not liable for the loss or theft of any personal property. Each person is responsible for safeguarding his or her own property.

Please Enter Date *

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Your Signature *

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