Waxing Consent & COVID release

Name

First Name Last Name

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Address

Street Address

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City State / Province

Postal / Zip Code

Phone Number

Area Code Phone Number

Haave you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours on area to be waxed?

Yes No

Have you used Retin-A, Renova, or Accutane within the past year? If so, when?

Are you using any other skin thinning products and/or drugs that thin the blood?

Yes No

Do you use tanning beds and/or are exposed to the sun on a regular basis?

Yes No

Are you currently taking any medications? If so, please list.

Have you been treated for cancer? If yes, when and what types of therapies were used?

Please list any illness/conditions which you are currently being treated for by a medical professional.

Do you have any open skin lesions?

Yes No

Do you have any allergies? If so, please list.

Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc.

I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my Esthetician. I give permission to my Esthetician at MaddTan LLC to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that my Esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that MaddTan LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I further acknowledge that MaddTan LLC can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families.

I voluntarily seek services provided by MaddTan LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19.

I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.

I attest that:

* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.

*I have not traveled internationally within the last 14 days.

* I have not traveled to a highly impacted area within the United States of America in the last 14 days.

* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.

* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.

* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

I hereby release and agree to hold MaddTan LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from MaddTan LLC. I understand that this release discharges MaddTan LLC from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from MaddTan LLC. This liability waiver and release extends to the salon together with all owners, partners, and employees.

I will notify MaddTan LLC if I develop symptoms or are tested for COVID within 14 days of being seen (initial below)

Signature

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Date

COVID-19 Waiver