Tanning Facility Parental Consent Form

  • The Tanning Facility Parental Consent Form is available in both English and Spanish in Portable Document Format (PDF).

Ultraviolet Radiation

Ultraviolet (UV) radiation is a human carcinogen and can cause skin cancer. Overexposure to UV radiation from tanning devices can cause burns and injury to the skin and eyes, premature aging of the skin and allergic reactions. Overexposure to UV radiation can reduce immunity, making your body less able to fight infection. It can also worsen existing medical conditions.

My minor child will not exceed the manufacturer's maximum exposure time when using a tanning device.

Ultraviolet Radiation Sensitivity

A combination of UV radiation and certain foods, cosmetics or medications can increase sensitivity to UV radiation. This is called "photosensitivity."

I am aware that the use of UV radiation is not advised when eating certain foods or when using certain cosmetics or medications. I will consult a physician before my minor child uses a tanning device if my minor child is using photosensitive medications, has a history of skin problems or if I believe that my minor child is especially sensitive to sunlight. I am aware that if my minor child does not tan in the sun, he or she is unlikely to tan from the use of a tanning device.

Tanning Hazards Information Sheet

My minor child and I have been given a copy of the New York State Department of Health Tanning Hazards Information Sheet.

Protective Eyewear

Failure to use Food and Drug Administration (FDA) certified protective eyewear can result in severe burns or injury to the eye, such as photokeratitis, cataracts, macular degeneration and melanoma.

My minor child agrees to wear FDA certified protective eyewear.

Parental Consent

I am the parent or legal guardian of a minor child who is seventeen (17) years of age.

Print the name of your minor child ___________________________Date of Birth of Minor Child ______________

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

My minor child and I have read and understand the hazards of tanning so that I can make an informed judgment about indoor tanning and the use of tanning devices.

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

This consent will expire one year from the date signed.

Signature of Parent or Legal Guardian _______________________________________________ Date________

Print name of Parent or Legal Guardian __________________________________________________________

Signature of Operator or Employee _______________________________________________ Date ___________

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