Golden Tan Salo] E 8927 Commercial ;t. New Minas, N.S B41 3E
|
|
|
- Irma Dulcie Johnson
- 5 years ago
- Views:
Transcription
![[ZT09 ON X21/XZl VTT OHM OT/TO/Z T Golden Tan Salo] E 8927 Commercial ;t. New Minas, N.](/docs-images/83/88160416/images/1-0.jpg "S B41 3E1 902-681-8090 To Law Administrative committee : I am writing to you in regards to the proposed Bil l tanning for anyone under age 19 as well as make other ch i run day to day.")
1 [ZT09 ON X21/XZl VTT OHM OT/TO/Z T Golden Tan Salo] E 8927 Commercial ;t. New Minas, N.S B41 3E To Law Administrative committee : I am writing to you in regards to the proposed Bil l tanning for anyone under age 19 as well as make other ch i run day to day. I feel it would be a mistake to make these a be government who decides if someone should or should z individual and in some cases the parents (depending on the many young adults who work in tanning salons, especiall y they would no longer be able to have this income as well & experience on working in a service industry. They learn a tanning beds, besides the smart tan training they receive it 4 to deal with customers, work as a team and I've know son ( them decide what to go on to take in college or university working in a salon. Tanning salons are constantly being portrayed as s ( should avoid by individuals who are only looking at one s : used the sun for many reasons for centuries and if you ask with a base tan they will tell you it helped keep them fro m their vacation instead of hiding inside the resort. If you thi you image trying to live without it? What we need is balari that most salons, especially the ones who have gone throu i equipped to help customers make a wise choice about tanrc people think they are helping by trying to bring these than, have their heads stuck in the sand if they believe that there controlled UV exposure. I hope that you will choose to not pass this bill an d smart tan and the joint Canadian tanning association (JCT.: tanning industry. Other provinces have found balance in r c don't take a step backwards and prove that we still have a I the people and not just the ones with more power. 102, which is seeking to ban ages to how tanning salons ar e hanges because it should not got tan, this should be up to th e age of the person). There are during the busy season an d 3 the opportunity to get of more than just how to clean teaches them confidence, how e who have told me it helped >ecause of their experience s ~mething bad that peopl e de of tanning. People have someone who has gone south burning so they could enjoy k the sun is bad for you, can e and moderation and I fee l it smart tan training are well ing. I'm sure well meaning es into effect but they must are no benefits to moderate, work with organizations like 0 to help find balance for the Bards to tanning so pleas e overnment who will listen to Sincerely, Kim Young TO/TO D9 d 6121 S31dd1S ZZTTT89Z06T. Fa :7.T GIT271Ta /7 T
2
3
4 4
5
6 JCTA Skin Typing Form Name Address City Postal Code Date of Birth! / Month Day Yea r Phone : Home : Business : How did you hear about the salon? Please complete the following questions to help us create your Skin Type and your specific exposure schedule : 1. A. What is the natural color of your untanned skin? E. What best describes your genetic heritage? _ (0) Reddish-white _ (0) Celtic Caucasia n (2) White-beige _ (2) Caucasian, light skinned Europea n - (4) Beige _ (4) Caucasian, dark skinned Europea n - (8) Light Brown _ (8) Caucasian, Mediterranea n -_ (12) Brown _ (12) Middle Eastern, Indian, Asian, Hispani c (16) Black_ (16) Aborigine, African, African-America n B. What is your natural hair color? F. Which best describes your Sunburn potential? (0) Red, light blonde (0) Always burn without tannin g -_ (2) Blonde, light brown _ (2) Usually burn but can ta n (4) Brown _ (4) Occasionally burn but tan moderatel y -_ (8) Dark brown _ (8) Seldom sunburn and tan easil y _ (12) Brownish-black _ (12) Rarely sunburn and tan profusely (16) Black_ (16) Never sunburn -C. What is your eye color? G. Which best describes your tanning potential? (0) Light blue, light green, light gray _ (0) Never Ta n - (2) Blue, green, gray _ (2) Can tan lightl y - (4) Grey, light brown _ (8) Can tan moderatel y - (8) Brown _ (12) Can get a dark ta n - (12) Dark brown - (16) Blac k D. How many freckles do you naturally hav e on your untanned body? Now add the points from your seven answers t o determine your total score. The Salon Certified staff will give you your Skin Type. (0) Man y - (2) Som e -_ (4) Few (8) Non e - TOTAL SCORE YOUR SKIN TYPE 2. Have you ever been seriously sunburned? Yes No (If yes, how long ago? years ) 3. Have you ever had an allergic reaction to sunlight? Yes No If yes, what type of reaction 4. Are you taking any medication which might cause you to be particularly sensitive to light? Yes No (Check with you pharmacist or doctor before you start tanning ) 5. Has any medical doctor recommended that you avoid sunlight or ultra-violet light? Yes No NOTE: Eye protection is mandatory. Special glasses are availabl e RELEASE AND INDEMNIFICATIO N I have chosen to use the tanning equipment being offered by this Salon ("Salon") and in consideration of permitting me t o use the tanning equipment I do fully and unconditionally agree to and acknowledge the following : 1) I am fully aware of, freely accept, and fully assume all the risks of injury, illness, and aggravation of medical conditions that are, or may be, inherent in the use of tanning equipment. I represent to Salon that I have been advised to consult with my famil y physician or other health authority regarding my intention to use the tanning equipment, and that I am otherwise health y and capable of using such equipment, 2) I hereby discharge, relinquish, waive, and release Salon and/or its officers, directors agents, servants, volunteers, employees, other tanning participants, parent company, subsidiaries and affiliate s (all of whom are collectively referred to as "Releasees") from any and all loss, damage, expense, injury, accident, and/o r liability of any kind or nature whatsoever in connection with my use of tanning equipment, including personal injury o r death 3) I further indemnify, save, defend, and hold harmless Salon and the Releasees from all claims, actions and/o r expenses which might arise from any use of the tanning equipment, 4) I hereby sign and deliver this Release an d Indemnification to Salon to induce Salon to permit my use of tanning equipment, and I hereby acknowledge that such us e is at my own risk and without any representation of any kind or nature having been made by Salon or the Releasees. I HAVE READ, FULLY UNDERSTAND, AND FULLY AGREE TO COMPLY WITH ALL OF THE ABOVE. Date : Signature of Participant: Signature of Witness :
7 Skin Type Score Add up all the points to get the total score and match the TOTAL with the correct skin typ e listed below. Make sure your client has not made any mistakes. Score Skin Type Descriptio n 0-7 Skin Type I DO NOT TAN THIS PERSO N 8-21 Skin Type II Sensitive to sunligh t Skin Type III Normal sensitivity to sunligh t Skin Type IV Skin is tolerant of sunligh t Skin Type V Skin is brown. Very toleran t 85+ Skin Type VI Skin is black. Extreme tolerance The JCTA would like to thank the International Smart Tan Network for letting th e association use parts of the 12th Edition of the Canadian Basic Technical Certification Manua l SKI N TYPE CHARACTERISTICS SKIN RESPONSE TO U V - Unexposed skin is bright white - Blue or green eye s - Red or Blonde Hai r - Freckle s - Heritage is English, Irish, Scottish, or Northern Europea n - Always burns easily and severely - Peel s - Does not ta n DO NOT TAN THIS PERSO N - Unexposed skin is white - Blue, hazel, or brown eye s - Red, blonde, or brown hai r - Heritage is same as Skin Type I or Scandinavia n - Burns easily and severely - Peels - Tans minimally or lightly - Unexposed skin is fai r - Brown eye s - Dark hai r - Heritage is Central or southern Europea n (Spanish, Greek, or Italian ) - Burns moderately - Tans averag e - Unexposed skin is light brow n - Dark eye s - Dark hai r - Heritage is Mediterranean, Oriental, or Hispani c - Burns minimally
8 - Tans easily and above average with eac h exposure - Exhibits IPD (Immediate Pigmen t Darkening ) - Unexposed skin is brow n - Dark eye s - Dark hai r - Heritage is East Indian, American Indian, Asian, Hispanic, - Latin American, or African America n - Rarely bum s - Tans easily and substantiall y - Always exhibits IP D - Unexposed skin is black - Dark eye s - Dark hai r - Heritage is African American or Aborigin e - Rarely bums - Tans easily and profusel y - Always exhibits IPD
Personal Profile and Health History
--CAPITAL AESTHETICS Personal Profile and Health History Name: Home Phone: Address: Work Phone: City/State/Zip: Date of Birth: Age: Gender: M F Occupation: Email address: How did you hear about us? What
Welcome to Medspa 1064, Connecticut s Premier Center for Cosmetic Laser Medicine
MedSpa 1064 Suites at Somerset Square 140 Glastonbury Blvd. Glastonbury, CT 06033 860.657.1064 Welcome to Medspa 1064, Connecticut s Premier Center for Cosmetic Laser Medicine This form is to introduce
Intake Form Chemical Peels, Microdermabrasion, and Facials
Intake Form Chemical Peels, Microdermabrasion, and Facials Name: Today s Date: Last First MI Street address: City: State: Zip: Date of birth: Age: Sex: 0 Female 0 Male Home Phone: Cell Phone: Leave messages
HEALTH HISTORY INFORMATION
HEALTH HISTORY INFORMATION Name: Today s Date: Last First MI Street address: City: State: Zip: Date of birth: Age: Sex: Female Male Home Phone: Cell Phone: Leave messages at: Home Cell Other: Email address:
Alani Medical Spa Medical History and Information
Alani Medical Spa Medical History and Information Birth date: _/_/_ SS#/_/_Email_ Today s Date: _/_/_ Name: (Mr.) (Mrs.) (Miss) Home Address: _ Work Address: _ Home Phone: ( ) Work Phone: ( ) _ Phone Number
AREA OF BODY TATTOO IS SITUATED?
CLIENT CONSULTATION LASER TATTOO REMOVAL FORM Address: Date of Birth: Suburb: State: Postcode: Telephone: Work: Mobile Home: Other: Email Address: How did you hear about us? Tattoo Removal Colours in tattoo
PIERCING CONSENT RELEASE FORM PLEASE READ AND CHECK THE BOXES WHEN YOU ARE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING THIS DOCUMENT
PIERCING CONSENT RELEASE FORM PLEASE READ AND CHECK THE BOXES WHEN YOU ARE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING THIS DOCUMENT In consideration of receiving piercing from (Name of Practitioner)
Client Information Sheet
Esthetic Laser Clinic 8381 Old Courthouse Road Suite 300 Vienna, VA 22182 (703) 288 0085 www.elaserclinic.com Client Information Sheet Last Name First Name: Address City State Zip Code D.O.B. (MM/DD/YY)
City State Zip. Model Dress size 6X 10 Height Weight Date of Measurement
Model Application 2016 American Girl Fashion Show Presented by the Junior League of the Lehigh Valley Saturday, March 5, 2016 10 AM & 2 PM Sunday, March 6, 2016 10 AM & 2 PM Model Fee $40 Thank you for
INFORMED CHEMICAL PEEL CONSENT. 1. I authorize the chemical peel listed above, to my face and / or neck, chest and hands.
INFORMED CHEMICAL PEEL CONSENT 1. I authorize the chemical peel listed above, to my face and / or neck, chest and hands. 2. Depending on the chemical peel site, there may be redness and/or irritation and
Eyelash Extension History & Consent Form
Eyelash Extension History & Consent Form Client Name: Date: Address: City: State: Zip: Home #: Business #: Cell #: Email: How may we contact you regarding scheduled appointments or specials? Check all
Chameleon Medical Spa NEW CLIENT HISTORY
NEW CLIENT HISTORY This information will allow your professional skincare specialist to provide the optimum products and services. First Name: Last Name: Date: Birth date: Address: City: State:_ Zip code:
East Hill Medical Group
Name: of Birth: Address: City: State: Zip: Home Tel. #: Cell #: Employer: Occupation: Emergency Contact: Relationship: Phone: Email: How Referred: Parents Ethnic Background: Previous Treatments Year: Area(s):
Personal Profile and Health History
--CAPITAL AESTHETICS Personal Profile and Health History Name: Home Phone: Address: Work Phone: City/State/Zip: Date of Birth: Age: Gender: M F Occupation: Email address: How did you hear about us? What
East Hill Medical Group
Name: of Birth: Address: City: State: Zip: Home Tel. #: Cell #: Employer: Occupation: Emergency Contact: Relationship: Phone: Email: How Referred: Parents Ethnic Background: Previous Treatments Year: Area(s):
Beautiful You LLC. Laser Hair Removal Pre/Post Treatment Care
Beautiful You LLC Laser Hair Removal Pre/Post Treatment Care Pre-Treatment Instructions Avoid deep tanning, including tanning beds and tanning creams, 2 weeks before and 1 week after treatment. If you
Contact Information. Idaho Falls. Idaho Falls, ID (208) (307) NAME. City / state / zip
Contact Information NAME physical street address City / state / zip Home phone cell phone email address want monthly specials? date of birth Age gender Male female How did you hear about us? WHICH AREAS
INFORMATION NOTE No 354: SUNBED REGULATION ACT 2010
INFORMATION NOTE No 354: SUNBED REGULATION ACT 2010 First issued: September 2010 ABOUT ISRM This is one of a series of Information Notes produced by the Institute of Sport and Recreation Management, the
Informed Consent For Facial Rejuvenation/Collagen Remodel
Informed Consent For Facial Rejuvenation/Collagen Remodel Client s name: Date: I authorize SilkySkin Laser Centers to perform the laser procedure. You will be treated with the Cynosure Elite TM laser,
ART SHOW ENTRY FORM DEADLINE: JUNE 1 APPLICANT INFORMATION ARTWORK INFORMATION: 1 ST ENTRY ARTWORK INFORMATION: 2 ND ENTRY
APPLICANT INFORMATION NAME STREET ADDRESS APARTMENT / UNIT CITY STATE ZIP PHONE EMAIL ENTRY FORM ARTWORK INFORMATION: 1 ST ENTRY TITLE MEDIUM (painting, photo, etc.) LENGTH HEIGHT WIDTH FOR SALE? PRICE?
Be the Fairest of Them All. Florence Nightingale Museum Youth Panel
Be the Fairest of Them All Florence Nightingale Museum Youth Panel Introduction In August 2015, the Florence Nightingale Museum Youth Panel worked on a project to examine the notions of beauty, pallor
Permanent Makeup Intake Form
Permanent Makeup Intake Form Artist Information (the Artist ): Chrystal Ladouceur 1530 McTavish Road, North Saanich, B.C., V8L 5T3 Client Information (the Client ): First Name Email Mobile Phone Address
Application for Tattoo / Body Piercing Establishment License Please print legibly in ink or type application.
United City of Yorkville 800 Game Farm Road Yorkville, Illinois 60560 630-553-4350 Application for Tattoo / Body Piercing Establishment License License Term January 1 through December 31 Application Fee
COUNTY OF SACRAMENTO STORM DRAIN STENCILING PROGRAM PROJECT APPLICATION
COUNTY OF SACRAMENTO STORM DRAIN STENCILING PROGRAM PROJECT APPLICATION Submit your completed application form to: County of Sacramento Water Resources Division Attn: Storm Drain Stenciling Program 827
ibrow Studio Client Information Packet
ibrow Studio Client Information Packet Thank you so much for trusting me with your beautiful face! Prior to booking an appointment, we ask that all ibrow Studio clients read and review the information
Art in the Plaza Guidelines
Art in the Plaza Summer Art Market in Century Plaza Who: We are seeking individuals who create local, handmade artworks and crafts ranging from paintings and photography to glasswork and carvings. We are
Imbue Aesthetics & Wellness PATIENT REGISTRATION FORM
Today's Date Legal Name Marital Status Sex DOB Age Mailing Address Preferred Phone Number Email Do we have your permission to add you to our email list to receive newsletters and promotions? YES NO Emergency
Registration & History Form. Client Name: Date: Address: City: State: Zip: Phone No.: Birthday: Anniversary: How did you hear about us?
Registration & History Form Client Name: Date: Address: City: State: Zip: Phone No.: Email: Birthday: Anniversary: How did you hear about us? Name of person who referred you: Phone: Question Y N Date and
ARIZONA AMERICAN INDIAN TOURISM ASSOCIATION(AAITA) Arizona Indian Festival Artisan Application Information
ARIZONA AMERICAN INDIAN TOURISM ASSOCIATION(AAITA) Arizona Indian Festival Artisan Application Information 2019 Arizona Indian Festival Scottsdale Civic Center Mall, 3939 N. Drinkwater Blvd. Scottsdale,
CLIENT QUESTIONNAIRE TODAY S DATE: SPECIFIC CONCERNS REGARDING YOUR SKIN (CHECK ALL THAT APPLY) I AM INTERESTED PRIMARILY IN:
CLIENT QUESTIONNAIRE TODAY S DATE: NAME: DATE OF BIRTH: SPECIFIC CONCERNS REGARDING YOUR SKIN (CHECK ALL THAT APPLY) Fine Lines/Wrinkles Dark Circles Puffy Eyes Blotchiness/Discoloration Uneven Skin Tone
ANNUAL SWEDISH MS CENTER ART SHOW
ANNUAL SWEDISH MS CENTER ART SHOW 2018 Art Show Application Form To participate in the Annual Swedish MS Center Art Show, submit this application form and your artwork/s by 4:00 p.m. on Friday, May 25,
GENERAL CONSENT AND PROCEDURE PERMIT FORM
GENERAL CONSENT AND PROCEDURE PERMIT FORM Please read this form fully and sign at the end. If you are unsure about a particular detail of the form, please speak to your therapist. If unforeseen condition
Micropigmentation (Semi-Permanent Makeup) Informed Consent
Micropigmentation (Semi-Permanent Makeup) Informed Consent The nature and method of the proposed semi-permanent makeup (cosmetic tattoo) procedure has been explained to me as having the usual risks inherent
2017 Union County Fair Pageant
2017 Union County Fair Pageant Date: Saturday, October 21, 2017 Location: Time: Ages: Entry Fee: Union County Fairgrounds Stage 120 Kirby Street Union, SC 29379 3 pm - until 3 Months-24 years old $80.00
2017 American Indian Arts Marketplace at the Autry November 11 & 12, 2017
2017 American Indian Arts Marketplace at the Autry November 11 & 12, 2017 Artist Booth Application Applications must be received by Friday, May 26, 2017 Application fee of $25. (non-refundable) is due
Maya Med Spa 6330 Broadway Blvd. Suite B, Garland, TX Name: Date of birth: Address: Pharmacy of your choice:
Client Consultation Name: Date of birth: Address: Home Phone: Cell Phone: Business Phone: E-mail address: Married: Yes No If yes, anniversary date: Employer: Occupation: Pharmacy of your choice: Does your
Date: Date of Birth: Gender: Male Female. City: State: Zip: Caucasion a African-American Hispanic Asian East Indian American Indian
Contact Information: Date: Date of Birth: Gender: Male Female Name: Address: City: State: Zip: Home Phone: Work/Day Phone: Cell: Email: Emergency Contact: Emergency Contact Phone: Medical Background Ethnic
Miss Chattahoochee Valley s Outstanding Teen Scholarship Pageant 2019 Local Contestant s Contract
Miss Chattahoochee Valley s Outstanding Teen Scholarship Pageant 2019 Local Contestant s Contract Miss Chattahoochee Valley s Outstanding Teen Pageant Org. enters into the following contract with, a contestant
Welcome to Bella! Give the Gift of Bella. A few tips to prepare you for your first visit: Gift Certificates are just $100 for a $150 value!
Welcome to Bella! We are glad to have you as our guest. We encourage you to visit our website to see all of the exciting new laser and skincare treatments that we offer. Please be aware of our 24 hour
HEALTH HISTORY. Name Date DOB Age. Home Phone Work Mobile Other
HEALTH HISTORY To ensure both the effectiveness and the safety of your treatment, please complete this health history as accurately as you can. PERSONAL INFORMATION Name _ Date DOB Age Address _ City State
HISTORY CARD. [ ] Face: Nose [ ] Face: Sideburns [ ] Glabella [ ] Gluteal [ ] Hands & Feet
![HISTORY CARD. [ ] Face: Nose [ ] Face: Sideburns [ ] Glabella [ ] Gluteal [ ] Hands & Feet](/thumbs/77/74907590.jpg "HISTORY CARD. [ ] Face: Nose [ ] Face: Sideburns [ ] Glabella [ ] Gluteal [ ] Hands & Feet")
HISTORY CARD Name: Date of Birth: / / Street Address: City: State: Zip: Telephone: (Home) Email: MEDICAL HISTORY Are you under a doctor s care: Yes [ ] No [ ] Please list any recent surgeries/injuries:
Remove bandage after two hours petroleum free For the first 3-5 days After a few days When you discontinue the plastic wrap petroleum free
TATTOO HEALING CARE Once the tattoo procedure is done, proper aftercare is essential to the healing, and will affect the outcome of your tattoo. Improper care or neglect during the healing process can
Fort Mac Unveiling Celebration May 19 th, 2018
Fort Mac Unveiling Celebration May 19 th, 2018 Fort MacPherson will hold an art and crafts festival as part of its unveiling celebration on May 19 th, 2018. These beautiful parks have lovely trees and
Pre-Treatment Advice and Procedures
1 Client copy Pre-Treatment Advice and Procedures Since delicate skin or sensitive areas may swell slightly, or redden, it is advised not to make social plans for the same day. Lip liner may appear "crusty"
Laser Hair Removal. Name Date of Birth. Address City State Zip. Home Tel. # Cell # How Referred
Laser Hair Removal Name of Birth Address City State Zip Home Tel. # Cell # Email How Referred Ethnic Background Previous Treatments Year Area(s) Hair and Skin Question - DO NOT use White, Jewish or Caucasian.
IPL CONSULTATION AND LIABILITY DOCUMENTATION
Name...... Address:... Date of Birth:... Suburb:... Postcode:... Home Phone:... Mobile:... Email Address:... How did you hear about us?... Contact in case of emergency:... Place a tick in the areas of
Pre Treatment Advice and Procedures
Pre Treatment Advice and Procedures 1. Since delicate skin or sensitive areas may swell slightly, or redden, it is advised not to make social plans for the same day. Lip liner may appear crusty for up
513 Maple Ave West, Vienna, VA
CLIENT INFORMATION AND CONSENT FORM: SKIN CARE Name Date of Consultation Address City State Zip Home phone ( ) Cellular phone ( ) E-mail Date of birth Emergency contact and telephone number How did you
Swiss textile testing and certification
Swiss textile testing and certification UV Standard 801 Natural UV radiation Sunlight is important for human health. The body needs it to form vitamin D, for example, which is important for bone structure.
5504 Backlick Road Springfield, Virginia
Name: Address: Phone: City: Zip Code: Cell: Phone: Text Cell Phone email How did you hear about us: General Health State: Contact me by 1. Rate your level of stress: (5 = highest, 1= lowest) 5 4 3 2 1
Drayton Community Infant School
Drayton Community Infant School Sun Screen Policy To underpin the values and ethos of our school and our intent to ensure our children/young people are appropriately safeguarded this policy is included
NEW CLIENT GENERAL INFORMATION FORM
NEW CLIENT GENERAL INFORMATION FORM First Name: Last Name: Email: Date of Birth: Occupation: Home Phone: Cell Phone: Carrier: Gender: Female Male Preferred Staff Gender: Female Male Preferred Staff Member:
SAFEGUARDING YOUR FINANCIAL INFORMATION
SAFEGUARDING YOUR FINANCIAL INFORMATION The application for the 2018 American Indian Arts Marketplace at the Autry will be available the first week of March online at theautry.org/marketplace. In order
CR EM ATION SELECTIONS
CR EM ATION SELECTIONS WHY CHOOSE BOSTON CREMATION? YOU ASKED, AND WE Listened More and more consumers are turning to the internet to make important decisions. They desire a process that gives them total
Psoralen Tablets (Methoxypsoralen)
Psoralen Tablets (Methoxypsoralen) Psoralen (Methoxypsoralen) Tablets This information is intended to provide you with information about your treatment and should be read thoroughly so that you are aware
PRODUCT YES / NO BRAND NAME PRODUCT NAME FREQUENCY OF USE
Consultation Form Today s Date: Name: Your Birthday: Spouses Name: Spouses Birthday: Anniversary: Address: City: St: Zip Home Phone: Office Phone: Cell Phone: Email Address: Purpose for visit: How did
Which trimester? 1 2 3
Registration & History Form Client Name: Date: Address: City: State: Zip: Home #: Business #: Cell #: Fax #: Email: Facebook Account: Twitter Name: How may we contact you regarding scheduled appointments
Aesthetic Patient Form
Aesthetic Patient Form Name: Date: Address: City: State: Zip: Home Phone: Work Phone: Cell: Age: Date of Birth: Occupation: Email: FITZPATRICK CLASSIFICATION SYSTEM: Please select the skin type that seems
PROTECT YOUR SKIN YOUR HEALTH AT SEA 3. Merchant Fishing Yachts
PROTECT YOUR SKIN YOUR HEALTH AT SEA 3 Merchant Fishing Yachts Contents Introduction....3 Where are the global high risk areas?...4 Who is at risk from skin cancer...5 What are the dangers....5 Can I protect
Application Form for Open Training Program & NICA Alumni 2019
OPEN TRAINING APPLICATION FORM CORE AND NON-CORE TIMES: Your Details: First Name: Address: State, postcode: Mobile: Year Degree completed at NICA: Surname: Suburb: Email: DOB: About your practice: Under
Your Kids and the Sun
Your Kids and the Sun Please click on any of the links below to go directly to your specified topic within this document. How Does the Sun Harm Our Skin? Some Skin Cancers Can Be Deadly Childhood Sun Protection
TATTOOING, BODY PIERCING, PERMANENT COSMETICS & BRANDING APPLICATION FOR REGISTRATION
TATTOOING, BODY PIERCING, PERMANENT COSMETICS & BRANDING APPLICATION FOR REGISTRATION 1. GENERAL PRACTITIONER INFORMATION New Registration Annual Registration Updated Registration FULL LEGAL NAME (Give
SOUTH BAY LIPO LIGHT
SOUTH BAY LIPO LIGHT FACIAL TREATMENT INTAKE FORM Your success is our #1 priority. PLEASE ANSWER ALL QUESTIONS Help us to help you achieve success by filling out this questionnaire as completely as possible.
Patient Information. M.I. Address: DOB: Sex: M F City: State: Zip: Social Security Number: / / Whom may we thank for referring you?
Today's : First Name M.I. Address: DOB: Sex: M F City: State: Zip: Social Security Number: / / Home Phone: ( ) Work Phone: ( ) Cell Phone: ( ) Patient Information Last Name Email: Primary Care Physican:
Science at Work Sensors: Loggers: EASY Logging time: Teacher s notes 18 How good is my suntan cream? Read Other questions you may be able to answer
Sensors: Loggers: Ultraviolet Any EASYSENSE Science at Work Logging time: SnapShot mode Teacher s notes 18 How good is my suntan cream? Read Most students will have heard about the dangers of ultraviolet
Rainbow Springs Art, Inc W. Pennsylvania Ave., Dunnellon, Florida, 34431
Rainbow Springs Art, Inc. 20804 W. Pennsylvania Ave., Dunnellon, Florida, 34431 5th Annual Rainbow Springs Art Festival Saturday, November 23-10:00am-4:00pm & Sunday, 24th, 11:00am-4:00pm LOCATION: Historic
2017 SEAC Native Art Market November 10-11, 2017 Hyatt Regency Downtown 100 East 2 nd Street Tulsa, Oklahoma
2017 SEAC Native Art Market November 10-11, 2017 Hyatt Regency Downtown 100 East 2 nd Street Tulsa, Oklahoma Name: Tribal Affiliation: Address: Birth date: Telephone: daytime: ( ) after 5 p.m.: ( ) E-mail:
HAZARD COMMUNICATION PROGRAM
HAZARD COMMUNICATION PROGRAM I. Purpose In order to protect our employees and comply with 29 CFR 1910.1200 the Hazard Communication Standard, the following written Hazard Communication Program has been
2017 FISHAWACK FESTIVAL 46 th Anniversary
2017 FISHAWACK FESTIVAL 46 th Anniversary SATURDAY JUNE 10 th The Chatham Fishawack Festival is a downtown cultural heritage day that has evolved into an area-wide, annual celebration of our friendship,
Understand wellness, disease prevention, and recognition of symptoms. ESSENTIAL STANDARD - 7. PCH.1
Understand wellness, disease prevention, and recognition of symptoms. ESSENTIAL STANDARD - 7. PCH.1 7.PCH.1.2 Explain environmental, psychological, and social factors affecting excessive sun exposure CLARIFYING
Hair To Bare South. Client Name: Date:
Hair To Bare South Client Name: Date: I authorize Rachelle Stokes (Hair To Bare South) to perform the treatments. The purpose of these treatments is to diminish or remove unwanted hair. The quantity of
'Let Your Light Shine' (Matthew 5.v16) Sun Safety Policy. Approval Date: Spring Term 2018
'Let Your Light Shine' (Matthew 5.v16) Sun Safety Policy Approval Date: Spring Term 2018 Review Date: Spring Term 2019 OUR MISSION STATEMENT 'Let Your Light Shine' (Matthew 5.v16) At St. Stephen s Church
HOW TO USE. and make the most out of your cutaneous T-cell lymphoma (CTCL) treatment
HOW TO USE and make the most out of your cutaneous T-cell lymphoma (CTCL) treatment TARGRETIN gel should not be used by women who are pregnant, believe they may be pregnant, or are planning to become pregnant.
New Manhattan Studios
New Manhattan Studios New York City www.newmanhattanstudios.com Instagram: newmanhattanstudios FIRST SESSIONS WITH NEW MANHATTAN STUDIOS ANSWERS TO QUESTIONS FREQUENTLY ASKED BY NEW MODELS This PDF has
FASHION BOARD APPLICATION
FASHION BOARD APPLICATION 2013 2014 I HAVE ALWAYS BEEN INTERESTED IN FASHION, BUT I NEVER THOUGHT THAT A CAREER IN THE FASHION WORLD WAS ATTAINABLE FOR ME. AFTER BEING ON THE FASHION BOARD, I VE REALIZED
Newport Cosmetic Center
Shirin Afrasiabi, M.D, Inc. 2301 Newport Blvd, Costa Mesa, Ca 92627 (949) 548-5700 Appointment: Initial. We require a valid Credit Card at the time of booking to secure your appointment Cancellation and
IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF MISSOURI EASTERN DIVISION ) ) ) ) ) ) ) ) )
Whitmill v. Warner Bros. Entertainment Inc. Doc. 2 Att. 1 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF MISSOURI EASTERN DIVISION S. VICTOR WHITMILL, Plaintiff, v. WARNER BROS. ENTERTAINMENT
Narrow Band (TL-01) Treatment. Under review
Narrow Band (TL-01) Treatment Narrow Band (TL-01) Treatment This information is intended to provide you with information about your treatment and should be read thoroughly so that you are aware of the
Patient Contact Information. Name. Home Address. City State Zip
Patient Contact Information Name Home Phone Work Phone Cell Phone Home Address City State Zip E-Mail Date of Birth Emergency Contact Name and Phone Who Referred You To This Clinic? Would you like to receive
Last Name: First Name: Address: City: State: Zip Code: Telephone: Home: Work: Cell: Date of Birth: Sex: Female Male
SCULPSURE MEDICAL HISTORY FORM Last Name: First Name: Address: City: State: Zip Code: Telephone: Home: Work: Cell: Date of Birth: Sex: Female Male Email Address: Family Doctor: Phone: Pharmacy: Phone:
Client Intake Form. Name: Date: Address: City: ST: Zip: Phone:
Client Intake Form Name: Date: Last First Address: City: ST: Zip: Email: Phone: How did you hear about Skin Renew Day Spa? What are your main concerns? How long have you been experiencing your current
Medication Name Reason Taken Dosage Last Date Taken
CLIENT HISTORY FORM Print Name Location of Service: Email Birth Date Age Gender @ Female Address City State / Male Emergency Contact Name and Number Home Phone ( ) Cell Phone ( ) Today s Procedure Description:
Get Real. Real Skills. Real Jobs.
Get Real. Real Skills. Real Jobs. www.europeanschoolofesthetics.ca 294 William Avenue, Winnipeg, MB R3B 0R1, Phone: 204-944-8202, Fax: 204-944-8207, Toll Free: #1-877-829-8071, Email: info@europeanschoolofesthetics.ca,
Three Rivers Convention Center 9th Annual Tattoo Convention. Friday, September 21,2018 Saturday, September 22, 2018 Sunday, September 23, 2018
Three Rivers Convention Center 9th Annual Tattoo Convention Friday, September 21,2018 Saturday, September 22, 2018 Sunday, September 23, 2018 Exhibitor Agreement Booths will be available at a cost of $450.00
2018 SPRING ART SHOW
VISUAL Monroe Area Council for the Arts MONROE Arts And the ALLIANCE Announces the 2018 SPRING ART SHOW May 31 June 3 APPLICATION General Information: Visual Arts Alliance (VAA) members and students free.
Massey Medical. Medical History (Dermal Filler) MEDICAL INFORMATION: I am interested in the following services: Juvederm: Botox:
Medical History (Dermal Filler) Name: Date: _ Date of Birth: Phone: _ MEDICAL INFORMATION: I am interested in the following services: Juvederm: Botox: NO YES Allergies history of severe allergy or anaphylaxis.
Summary. This Guide provides safe work methods to prevent these injuries and illnesses.
3rd Edition R3 Safety Guide Summary Groundskeeping involves a wide range of tasks. Many of these tasks can cause bodily injuries or illnesses. You can prevent such injuries and illnesses by following safe
Informed Consent for Light Energy Tattoo Removal
Dr. Joseph G. Protain 813 Kentwood Dr. Boardman, OH 44512 (330)953-3515 Informed Consent for Light Energy Tattoo Removal Customer s name: Date: I, consent to and authorize and members of his/her staff
MANNATECH SKIN CARE PRODUCT SAFETY AND EFFICACY TESTING
MANNATECH SKIN CARE PRODUCT SAFETY AND EFFICACY TESTING The Food, Drug & Cosmetics Act does not require that cosmetics be tested for safety. The U.S. Food and Drug Administration (FDA) does advise cosmetic
Q1 Where do you live?
Q1 Where do you live? Answered: 37 Skipped: 0 Bucoda - inside the t... Lacey - inside the city limits Olympia - inside the c... Rainier - inside the t... Tenino - inside the t... Tumwater - inside the
CLEAR TOE INTAKE INFORMATION
CLEAR TOE INTAKE INFORMATION Name: Today s Date: Last First MI Street address: City: State: Zip: Date of birth: Age: Sex: Female Male Home Phone: Cell Phone: Leave messages at: Home Cell Other: Email address:
Laser Services New Patient Packet
Laser Services New Patient Packet Informed Consent for Laser Services This consent form is intended to provide you with the information needed to make an informed decision whether or not to undergo laser
If you have any questions about the pageant please contact me at or me at
Dear Contestant, Thank you for your interest in the 2018 West Virginia Strawberry Festival Teen/Queen Pageant on Sunday April 8 th 2018! Our pageant has been one of the premier pageants in West Virginia
WORD CHECK UP. Transgender. Invalidating. Affirm
DAY146 University ends use of Mr, Ms and Mrs A university in South Africa has decided to no longer use titles such as Mr Ms or Mrs. The University of the Witwatersrand said it will stop using these titles
CLIENT QUESTIONNAIRE
CLIENT QUESTIONNAIRE YOUR INFORMATION Name Age DOB Address City State Zip Home Phone Cell Phone Email MEDICATIONS Medication When How Long Medication When How Long Antibiotics Androstendione Accutane Testosterone
Pre-Treatment Advice and Procedures
Pre-Treatment Advice and Procedures 1) Since delicate skin or sensitive areas may swell slightly, or redden, it is advised not to make social plans for the same day. Lip liner may appear crusty for up
Miss Show Me State Pageant
Presents the 3 rd Annual Miss Show Me State Pageant Date: Sunday June 25 th, 2017 Time: 2PM Location: Cowan Civic Center Theatre 500 East Elm Street Lebanon, MO, 65536 Age Divisions (We categorize according
What Every Man Needs to Know About Waxing
PDF Version Published by Judy Zifka, Professional Waxer / Esthetician Copyright 2014 Judy Zifka all rights reserved No part of this may be reproduced without written permission from the author Acknowledgements
Client Consultation. Date of Birth: Address: Home Phone: ( ) Business Phone: ( ) Referred by:
Client Consultation Date: Name: Date of Birth: Address: Home Phone: ( ) Business Phone: ( ) Cell Phone: ( ) E-mail address: Married: Single: Employer: Occupation: Does your job require that you work outdoors?
STUDENT CAST INFORMATION PACKET
STUDENT CAST INFORMATION PACKET Welcome to the Xavier Scholarship Fashion Show! Sunday, March 15, 2015 The Phoenician PACKET INCLUDES: 1. Contract/Release Form (complete and bring to Parent/Student Meeting)