GAIA Micro Spa COVID-19 Liability Waiver

GAIA Micro Spa COVID-19 Liability Waiver

Please complete liability waiver NO MORE THAN 48 HOURS prior to your scheduled appointment.
Name *

First Name Last Name
Email *
example@example.com
Date of Your Appointment *

Month Day Year
Date
What best describes how you feel about your upcoming visit? *

I'm looking forward to my GAIA Experience I'm excited but, I want to spend as little time as possible in public.
Salon Service Pre-Screening

1. Have you been in close contact with any person diagnosed (confirmed by testing) with the COVID-19 Virus in the last 14 days?

Close contact is defined as;
- Being within approximatley 6 feet of a COVID-19 case.
- Close contact can occur when caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case.
- Having direct contact with infectious secretions of the COVID-19 case. (i.e. being coughed on)
Yes No
2. Have you been around anyone that has had a fever, cough, sore throat, muscle aches, or shortness of breath in the last 14 days?
Yes No
3. Are you experiencing acute lower respiratory illness (cough, shortness of breath) and fever?
Yes No
4. I understand that in order to recieve a salon service that I must wear a face mask or face shield.
I agree
Guest Liability Release

RELEASE OF LIABILITY AND AGREEMENT NOT TO SUE, INDEMNIFICATION, HOLD HARMLESS, LIMITATION OF WARRANTY

We all know that these are uncertain times. The risks of COVID-19 are not well understood and there is controversy among the experts on how the virus can spread and difficulty in scientifically determining whether anyone has the virus at any moment in time.

In consideration for providing haircuts and color, by signing below you agree to accept all responsibility for the risk that you may contract COVID-19. While we are taking your safety and that of our staff very serious, by employing new safety and sanitation initiatives, we cannot guarantee that any of these measures will completely protect you from contracting COVID-19.

I agree that if I take any steps to make a claim for damages against GAIA Micro Spa, its agents, employees or any other released parties arising out of my receipt of haircut or color services during my visit to GAIA Micro Spa, I shall be obligated to pay all attorney's fees and costs incurred as a result of such claim.

I acknowledge that I can go elsewhere to have my hair cut and colored and I acknowledge that GAIA Micro Spa is not the only hair salon where I can have my hair cut and colored. By signing this Agreement, I acknowledge that I am free to go to other salons who may not require my agreement to accept responsibility for contracting COVID-19 and I chose to have haircut and color services.

GAIA MICRO SPA RESERVES THE RIGHT TO TURN AWAY ANY GUEST THAT VISIBLY PRESENTS SYMPTOMS AS DESCRIBED ABOVE OR THAT HAS CHECKED YES TO ANY OF THE ABOVE QUESTIONS.

IN ADDITION, THE GAIA TEAM IS SCREENED DAILY AT ARRIVAL UTILIZING THE ABOVE PROTOCOLS. ANYONE ANSWERING YES OR EXHIBITING SYMPTOMS WILL NOT BE ALLOWED INSIDE THE BUILDING OR AT WORK UNTIL THEY TEST NEGATIVE FOR COVID-19 OR ARE SYMPTOM FREE.

Please sign attesting your information is accurate and true and that you accept responsiblity fully for your salon visit to GAIA Micro Spa.
Today's Date *

Month Day Year
Date
Signature *

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