Tanning Facility Parental Consent Form

Please read the following information and acknowledge that you understand and accept all provisions by signing below.

Avoid Overexposure

As with natural sunlight, overexposure can cause eye and skin injury and allergic reactions. Repeated exposure may cause burns, premature aging of the skin and skin cancer. My minor child will not exceed the manufacturer's maximum exposure times.

Ultraviolet Radiation Sensitivity

Certain medications or cosmetics or foods may increase your sensitivity to ultraviolet radiation.

I have been advised of conditions, such as the use of photosensitizing medications, cosmetics and foods under which the use of ultraviolet radiation is not advised. I will consult a physician before my child uses a tanning device if my child is using medications, has a history of skin problems or if I believe that my child is especially sensitive to sunlight. I am aware that if my child does not tan in the sun, he or she is unlikely to tan from the use of a tanning device.

Information Sheet

My child and I have been given a copy of the NYSDOH information sheet on tanning hazards.

Protective Eyewear

Failure to use FDA certified protective eyewear may result in severe burns or long-term injury to the eye. I agree to wear protective eyewear.

Signature of Minor __________________________________ Date____________

Consent

I am the parent or legal guardian of ________________________________________, a minor between the ages of 14 and not yet 18 years of age.
(print name of minor on line)

My child and I have been given adequate instruction in the operation of tanning devices.

My child and I have read and understand the contents of this form.

I give consent for my child to use the tanning devices in this facility.

This consent will expire one year from the date signed.

Signature of parent/legal guardian __________________________ Date________

Print name of parent/legal guardian _____________________________________

Operator or Designee signature _________________________ Date ___________