~ TAN WAIVER ~
PLEASE READ,SIGN, PRINT & HAVE READY FOR ME AT OUR APPOINTMENT
Informed Consent Form for Australian Kiss Sunless Tanners
Part 1 of 2
DHA is listed in the Food, Drug and Cosmetic Act (FD&C Act) as a color additive for use in imparting color to the human body. However, its use in cosmetics
- including sunless "tanning" products - is restricted to external application. According to the CFR, "externally applied" cosmetics are those "applied only to external parts of the body and not to the lips or any body surface covered by mucous membrane" (21 CFR 70.3v).
In addition, no color additive may be used in cosmetics intended for use in the area of the eye unless the color additive is permitted specifically for such use (21 CFR 70.5a). The CFR defines "area of the eye" as follows:
"the area enclosed within the circumference of the supra-orbital ridge, including the eyebrow, the skin below the eyebrow, the eyelids and the eyelashes, and conjunctival sac of the eye, the eyeball, and the soft areolar tissue that lies within the perimeter of the infra-orbital ridge." (21 CFR 70.3s)
Because the FDA has not specifically tested or reviewed DHA exposure for other than external use, it recommends that users take measures to protect exposure to eyes, lips, mucous membranes, and prevent inhalation. In accordance with these guidelines, we recommend the following:
• Like most cosmetics, avoid exposure to the eyes, as well as the immediate area surrounding the eyes.
• Avoid exposure to the lips and other parts of the body covered by mucous membrane. This can be accomplished by using a barrier product like a lip balm.
• Follow staff’s breathing instructions so as to avoid inhaling or ingesting the sunless product.
Please read the ingredients below to ensure our not allergic to any
Organic Aloe Barbadensis, Eco-Certified DHA, Lemon Peel Extract, Bergamot Oil, Macadamia Seed Oil, Mandarin Orange Peel Extract, Centipeda Cunninghamii , Grapefruit Seed Extract
Informed Consent Form for Sunless Tanners
Part 2 of 2
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 sunless tanning. I have been given adequate instructions for the proper use of the sunless application, 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 Sunless Spray Tanning.
Signature: _________________________________Date: __________________
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IF UNDER 18 YEARS OF AGE PLEASE READ & SIGN BELOW
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I HEREBY GIVE MY PERMISSION as parent ( ) or guardian ( ) of _________________________________ who is ____ years of age (permission required if under 18), to sunless tan with Australian Kiss .
I have read and fully understand this Client Release and Informed Consent Form and hereby agree to accept all of the provisions.
SIGNED: ________________________________ Date: ___________________
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