Rizzieri Guest COVID

Name*

First NameLast Name

Email*

example@example.com

In which location are you receiving your services?*

Date of Appointment*

Date

Prescreening and Acknowledgments

By signing this waiver, I acknowledge that:

I have not been in contact with anyone who has tested positive for COVID-19 or any variant of Covid-19 of any type within the past 14 days.

I am not experiencing any of the following; fever or chills; cough; shortness of breath or difficulty breathing; fatigue; muscle or body aches; headache; new less of taste or smell; sore throat; congestion or runny nose; nausea or vomiting.

I understand that there will be a $3.00 operational fee added to my ticket that is based on the costs associated with operating our business during the state mandated order.

I recognize that the staff at Rizzieri Salon, Spa and Franco's Barbering are closely
monitoring the current pandemic, consulting with medical professionals and have put in place the publicly identified preventive measures targeted to reduce the spread of Covid19 and its variants. However, given the nature of Covid-19 and the continuously changing medical and regulatory landscape, I understand there is a risk of becoming infected with COVID-19 or a variant if I proceed with this elective service/procedure.

I agree to release and hold harmless Rizzieri Salon, Spa and Franco's Barbering, and each of its owners, independent service providers and employees against any and all claims, suits, or actions, each of any kind whatsoever brought by me or anyone on my behalf.

I have been given the option to defer my service to a later date. However, I choose to assume any risk, I understand all the risks, including those noted herein and I would like to proceed with this service. Additionally, I have been offered a copy of this consent form and fully understand the explanation and consent to service.

I acknowledge that I am competent and capable and that I have carefully read this “COVID19 Pandemic Consent” and fully understand that it is my agreement to have services performed and acts as a release of liability for Rizzieri and its related companies and service providers in the event I contract the Covid-19 or a related virus.

Signature*