Name_________________________________________________________________________________
Address________________________________________________________________________________
City, State, Zip Code_______________________________________________________________________
Home Phone_______________________ Work _______________________ Cell______________________
DOB:_____/_______/______ Email:_________________________________________________________
We do not sell, share, or spam your email or other information. All information obtained is for contact purposes ONLY.
How did you hear about us? Internet phonebook friend other
Were you referred? Y N By who? ___________________________________________________________
Have you ever used a self-tanning product before? Y N
Did you have a reaction? Y N
If yes, please explain: _____________________________________________________________________
I understand that swimming, showering, and/or participating in any vigorous activity that results in
sweating can negatively impact the result of my tan if done within 8 hours of session.
I understand that there is a chance of my clothing being stained depending on the fabric. More so
if light colored or made of silk or leather.
I hereby relieve this establishment, and hold them harmless, from any liability involved in the use of the tanning process. At Your Fingertips and their agents or employees are not liable for any injury to person or property; or the loss or theft of any personal property.
Client Signature:_______________________________________________ Date_______________________
If client is under the age of 16:
I HEREBY GIVE MY PERMISSION as parent or guardian of ________________________________________,
who is _____ years of age, to airbrush tan at this facility.
I have read and fully understand this Client Release and Informed Consent Form and hereby
agree to accept all provisions.
Parent/Guardian Signature: _________________________________________ Date:____________________