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.
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