CONSENT FORM FOR CLIENTS OF SOLARIA	
Please read the following information carefully

(1) Tanning units emit ultraviolet radiation.
(2) Exposure to ultraviolet radiation contributes to the skin ageing process and skin cancer.
(3) Tanning unit exposure should be avoided for 48 hours before and after sunlight or tanning unit exposure.
(4) Protective eyewear must be worn at all times while undergoing tanning unit exposure.
(5) If you have fair skin and burn easily you will not be permitted to use a tanning unit.
(6) If you are under the age of 18 years you will not be permitted to use a tanning unit.
(7) There is additional risk, and tanning unit exposure is not recommended, if you:
(a) have ever been treated for solar keratoses or skin cancer, or
(b) have a large number of moles, freckles or naevi, or
(c) have a history of frequent childhood sunburn, or
(d) burn easily; or
(e) have ever suffered from an abnormal reaction, or allergy, to light.
(8) There may be further risk if you are pregnant, taking certain medications by mouth or applying medications or certain cosmetics to the skin.

If there is any doubt in your mind in relation to any of the particulars described in items (3), (7) or (8) above, consult your doctor before undergoing any ultraviolet exposure.
Consent
(1) I, ……………………………………………………………………………………… [Name], of
……………………………………………………………………………….. .[Address], am over the age of 18 years.
(2) I acknowledge that I have read and fully understand the above information.
(3) I acknowledge that an assessment of my skin photo type has been made.
(4) I consent to being exposed to ultraviolet radiation from a tanning unit in this establishment.
(5) I have not been exposed to ultraviolet radiation from a tanning unit in the last 48 hours.

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Signed (client) 									Date 

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Signed (operator)								Date

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Name of establishment