Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.First & Last Name *FirstLastAppointment Date & TimeDateTimeWhat is the length of your tanning session in minutes? (Cannot exceed 12 minutes.) *Date Of Birth (MM-DD-YYYY) *Phone Number *Email *Age Certification *I certify that I am 18 years of age or older. I understand that Minnesota law prohibits UV tanning for individuals under age 18.MINNESOTA STATE MANDATE 325H.085 states that use by minors is prohibited; a person under age 18 may not use any type of tanning equipment as defined by section 325H.01, subdivision 6, available in a tanning facility in this state. Acknowledgment of Risk *I understand the exposure risk that ultraviolet (UV) light, red light therapy and tanning devices may cause and I voluntarily choose to use tanning equipment despite these risks.MINNESOTA STATE MANDATE 325H.05 states that exposure to ultraviolet radiation may be dangerous. Risks may include but are not limited to: premature aging of the skin, eye injury if protective eyewear is not worn, allergic reactions, increased risk of skin cancer. Disclosure in + Health & Medication Disclosure *I confirm that I do not have a medical condition that would make UV or red light exposure unsafe. I am not currently using medications or products that cause photosensitivity (including certain antibiotics, acne medications, or topical treatments). I am not pregnant or have consulted a physician before tanning. If unsure, I will consult a healthcare provider before tanning.The following may increase skin sensitivity: • Perfumes and colognes containing furocoumarins. • Compounds from natural products such as plants and fruits (their natural oils can sensitize the skin to sunlight. • Food and fruits that contain photosensitizing agents: celery, carrots, lime, coriander, parsley, fennel, dill, buttercup, mustard and figs. A partial list of known photosensitizing medications is listed below by name: ACETOHEXAMIDE (DYMELOR) ACRIDINE PREPARATIONS (SLIGHT) AGAVE LECHUGUILLA (AMARYLLIS) AGRIMONY 9-AMINOACRIDINE AMINOBENZOIC ACID AMITRIPTYLINE (ELAVIL, ETC.) ANESTHETICA (PROCAINE GROUP) ANGELICA ANTHRACENE ANTIMALARIALS ARSENICALS BARBITURATES BAVACHE (CORYLIFOLIA) BENEZENE BENZOPYRINE BERGAMOT (PERFUME) BITHIONAL (ACTAMER, LOROTHIDOL) BLANKOPHORES (SULFA DERIVATIVES) BULOSEMIDE (JADIT) BROMCHLORSALICYLANILID 4-BUTYL-4- CHLOROSALICYLANILIDE CARBAMAZEPINE (TEGRETOL) CARBINOXAMINE D-FORM (TWISTON R-A) CARBUTAMIDE (NADISAN) CARROTS, WILD CEDAR OIL CELERY CHLOROPHYLL CHLOROTHIAZIDE (DIURIL) CHLORPROMAZINE (THORAZINE) CHLORTETRACYCLINE (AUREOMYCIN) CITRON OIL CITRUS FRUITS CLOVER COAL TAR CONTRACEPTIVES, ORAL DEMECLOCYCLINE DECLOMYCIN DIMETHYLCHLORTETACYCLINE DESIPRAMINE (NORPRAMIN, PERTOFRANE) DIBENZOPYRAN DERIVATES DICYANINE-A DIETHYLSTILBESTROL DIGALLOYL TRIOLEATE SUNSCREEN DILL DIPHENHYDRAMINE HYDROCHLORIDE EOSIN (SLIGHT) ESTRONE FENNEL FLOURESCEIN DYES 5 FLOUROURACIL GLYCERYL P AMINOBENZOATE GOLD SALTS GRASS (MEADOW) GRISEOFULVIN (FULVICIN) HEMATOPORPHYRIN HEXACHLOROPHENE (RARE) HEXACHLOROTHIAZIDE (ESIDRIX) IMIPRAMINIE HCL (TOFRANIL) ISOTHIPENCYL (THERUHISTIN) ISOTHIPENDYL LADY’S THUMB (TEA) LANTININ LAVENDER OIL LIME OIL MECLOTHIAZIDE (ENDURON) MEPAZINE (PACATAL) 9-MERCAPTOPURINE METHOTRIMEPRAZINE (LEVOPROME) METHOXSALEN (MELOYINE, OXSORALEN) 5 METHOXYPSORALEN 8-METHOXYPSORALEN MONOGLYCERAL PARA- AMINOBENZOATE MUSTARDS NALIDIXIC ACID NAPTHALENE NORTRIPTYLINE (A VENTYL) OXYTETRACYCLINE (TERRAMICIN) PARA- DIMETHLAMINOAZOBENZENE PARAPHE NYLENEDIAMINE PARSLEY PARSNIPS PENICILLIN DERIVATIVES PERIOLINE PERPHENAZINE )TRILAFON) PENANTHRENE PHENAZINE DYES PHENOLIC COMPOUNDS PHENOTHIAZINES (DYES, METHYLENE BLUE) PHENOXAZINES PHENYLBUTAZONE (BUTAZOLIDIN) PHENYTIOIN (DILANTIN) PITCH AND PITCH FUMES PORPHYRINS PROCHLORPERAZINE PROMAZINE HYDROCHLORIDE PROFRIPTYLINE PSORALENS PYRATHIAZINE HYDROCHLORIDE PYRIDINE QUINETHAZONE (HYDROMOX) QUYININE ROSE BENGAL PERFUME RUE SALICYLANILIDESSALICYLATES SANDALWOOD OIL (PERFUME) SILVER SALTS SMARTWEED (TEA) STILBAMIDINE ISETHIONATE SULFACETAMIDE SULFADIAZINE SULFADIMETHOXINE SULFAGUANIDINE SULFANILAMIDE (SLIGHT) SULFAMERAZINE SULFAMETHANIZINE SULFAPYRIDINE SULFATHIAZOLE SULFONAMIDES SULFAISOMIDINE (ELKOSIN) SULFONYLUREAS (ANTIDIABETICS) TETRACHLORSALICYLANILIDE TRETACYCLINES THIAZIDES (DIURIL, HYDRODIURIL) THIOPHENE THIOPROPAZATE DIHYDROCHLORIDE TOLBUTAMIDE (ORINASE) TOLUENE TRIBROMOSALICYLANILIDE (TBS) TRICHLORMETHIAZIDE (METHAHYDRIN) TRIDIONE TRIETHYLENE MELAMINE (TEM) TRIFLUPROMAZINE HYDROCHLORIDE (VESPRIN) TRIMEPRAZINE TARTRATE (TEMARIL) TRIMETHADIONE (TRIDIONE) TRIPYRATHIAZINE TRYPATLAVINE TRYPAN BLUE VANILLIN OILS WATER ASH XYLENE YARROWUV + Red Light Therapy Disclosure *I understand this device may use high-output UV lamps and/or red light therapy lamps (633nm). Red light therapy is cosmetic and not a medical treatment.MINNESOTA STATE MANDATE 325H.05 states that exposure to ultraviolet radiation may be dangerous. Risks may include but are not limited to: premature aging of the skin, eye injury if protective eyewear is not worn, allergic reactions, increased risk of skin cancer.Protective Eyewear Agreement *I agree to wear protective eyewear during the entire tanning session. If I do not bring protective eyewear I will be responsible for purchasing eyewear prior to my service. I understand failure to wear eyewear may result in eye injury.MINNESOTA STATE MANDATE 325H.05 states that exposure to ultraviolet radiation may be dangerous. Risks may include but are not limited to: premature aging of the skin, eye injury if protective eyewear is not worn, allergic reactions, increased risk of skin cancer.Skin Type & Exposure *I agree that I am not Skin Type 1 and will follow all recommended exposure times and frequency of visits.SKIN TYPE I - Sensitive Skin - This individual burns easily and should NOT tan. SKIN TYPE II - Light Skin - This individual burns easily and severely and should tan minimally. SKIN TYPE III - Normal Skin - This individual burns moderately and tans moderately. SKIN TYPE IV - Dark Skin - This individual burns minimally and tans well/ above average. MANUFACTURER'S RECOMMENDED EXPOSURE TIME (IN MINUTES): SKIN TYPE I - Tanning Not Advised SKIN TYPE II - WK One: 2 Minutes, WK Two: 4 Minutes, WK Three: 8 Minutes, WK Four and beyond: 12 Minutes SKIN TYPE III - WK One: 3 Minutes, WK Two: 5 Minutes, WK Three: 9 Minutes, WK Four and beyond: 12 Minutes SKIN TYPE IV - WK One: 4 Minutes, WK Two: 6 Minutes, WK Three: 10 Minutes, WK Four and beyond: 12 Minutes Tanning more than once every 48 hours is not allowed. No more than 3 tanning sessions are allowed per week.Release & Waiver of Liability *I voluntarily assume all risks associated with tanning. I release and hold harmless POPPY SALON, its owners, employees, and affiliates from any claims, damages, or injuries resulting from my use of tanning equipment, except in cases of gross negligence.We ask guests to acknowledge these sections so we can be sure everyone understands the safety guidelines and how to tan responsibly. It confirms that important information — like exposure timing, eyewear use, and skin sensitivity — has been clearly reviewed. This helps us provide a safe, professional experience for every guest. It’s simply part of our commitment to your safety and great results.Accuracy Statement *I certify that the information I provided is true and complete. I agree to inform POPPY SALON of any changes to my health, medications, or tanning history.This section confirms that the information you shared with us is accurate. Agreeing to keep us informed helps us protect your skin and tailor your sessions responsibly. It’s part of creating a safe and personalized experience for you.Date of Agreement *Consent & Digital Signature *By typing my full name above, I acknowledge that I have read, understand, and agree to this consent and waiver.Submit