COVID-19 Liability Release Waiver

STOP THE SPREAD
COVID-19 Liability Release Waiver

**Signature Required Prior to Every Scheduled Appointment**
Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), GlamHer Lash Studio, LLC/ PlasmaPro NY is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfection procedures in accordance with the New York Department of Professional and Occupational Regulation guidance.

Symptoms of COVID-19 include:
- Fever
- Fatique
- Dry Cough
- Difficulty Breathing
I agree to the following: *

I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the 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 knowingly 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 traveled 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 GlamHer Lash Studio, LLC/Plasma Pro NY 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.
GlamHer Lash Studio, LLC/PlasmaPro NY is following these enhanced procedures to prevent the spread of COVID-19:
- Prepayment for services available if clients prefer contactless checkout
- Additional time included between appointments to prevent client contact with eachother
- Guests accompanying those scheduled for services discouraged
- Each client required to wear a mask, receive a temperature check and wash hands upon arrival
- Your esthetician will thoroughly clean hands before all treatments
- Your esthetician will wear a clean set of arm coverings, cloth mask and for each client
- All skincare product bottles used during treatment will be placed on the trolley for disinfection and disposable items will be used when possible
- All surfaces will be wiped thoroughly with hospital grade disinfectant before and after each client according to the manufacturer's directions
By signing below, I agree to each statement above and release GlamHer Lash Studio, LLC/Plasma Pro NY from any and all liability for the unintentional exposure or harm due to COVID-19.

GlamHer Lash Studio, LLC/ PlasmaPro NY agrees to abide by these standards and affirms the same.
Date *

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Signature *

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