Taji Salon Covid-19 Consent Form

Please take a moment to complete our consent form. By submitting the form below you agree to knowingly and willingly consent to have hair services done during the COVID-19 pandemic. We reserve the right to refuse service if this form is not submitted. Thank you.
FirstLast
Date of your appointment *

MonthDayYear
Date
I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not given the current limits in virus testing.*

Yes
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of hair services, that I have an elevated risk of contracting the virus simply by being in the salon.*

Yes
I knowingly and willingly consent to have hair services done at Taji Natural Hair Styling*

Yes
I understand that I will need to wear a mask that covers my nose and mouth at ALL times during my visit. Neither eating or drinking is allowed at the salon therefore, I will need to step outside to eat or drink*

Yes
To prevent the spread of viruses and to help protect each other, I understand that I have to follow the salons strict guidelines of wearing a mask at all times over the mouth and nose, receiving a temperature check, and not eating or drinking in the salon.*

Yes
I understand that because of limited space, I cannot bring others who are not getting serviced with me to my appointment unless communicated to us as absolutely necessary.*

Yes
Are you presenting any of the following:*

A temperature higher than 100.4 degreesLoss of taste or smellShortness of breathSore throatDry coughRecently been tested for Covid-19None of the above
Have you been around anyone with the above symptoms in the past 14 days?*

YesNo
Do you live with anyone who is sick or quarantined?*

YesNo
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. And I understand that the CDC, OSHA, and North Carolina Board of Cosmetology recommend social distancing.*

Yes
Have you traveled outside the United States in the past 14 days?*

YesNo
If yes, where have you traveled?
Have you traveled domestically within the United States by commercial airline, bus, or train within the past 14 days.*

YesNo
If yes, where have you traveled?
Date*

MonthDayYear
Date
Signature

Clear
Should be Empty:

Please take a moment to complete our consent form. By submitting the form below you agree to knowingly and willingly consent to have hair services done during the COVID-19 pandemic. We reserve the right to refuse service if this form is not submitted. Thank you.