Bronze 'N' Beauty COVID-19 Liability Waiver

COVID-19 Liability Waiver

**Signature required prior to every scheduled appointment**
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Name

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Email
example@example.com
Address

Street Address

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Due to the 2019-2020 outbreak of the Coronavirus (COVID-19), Beauty By Jules is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfection procedures.

Symptoms may appear 2-14 days after exposure of the virus. People with these symptoms may have COVID-19. These symptoms include:

·       Cough

·       Shortness of breath or difficulty breathing

·       Fever

·       Headache

·       Tiredness

·       Chills

·       Muscle pain

·       Sore throat

·       Loss of taste or smell

By signing below, I confirm that:
I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced symptoms listed above WITHIN THE LAST 14 DAYS.
I affirm that I, as well as all household members have not been diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.
I affirm that I, as well as all household members have not knowlingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.
I affirm that I, as well as all household members have not travelled outside of the country, or to any city considered to be a 'hot spot' for COVID-19 infections WITHIN THE PAST 30 DAYS.
I understand that Bronze 'N' Beauty cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.
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