Covid-19 Pandemic Nail/ Skin/ Lash/ Permanent Cosmetic Consent Form
Please take a moment to complete our consent form. By submitting the form below you agree to knowingly and willingly consenting to have nail/ skin/ lash/ permanent cosmetic service during the COVID-19 pandemic. We reserve the right to refuse service if this form is not submitted. Thank You.
Name
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First Name
Last Name
Email
example@example.com
Phone Number
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-
Area Code
Phone Number
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.
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Yes
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of nail, skin, lash, and permanent cosmetic services, that I have an elevated risk of contracting the virus simply by being in the salon.
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Yes
I confirm that I am not presenting any of the following symptoms of COVID-19. I do not have a temperature above 98.7 degrees, shortness of breath, loss of sense of taste or smell, dry cough and or sore throat.
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I Am Not Presenting Symptoms.
I confirm that I have not been around anyone with these symptoms in the past 14 days.
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Yes
I do not live with anyone who is sick or quarantined.
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I Do Not.
To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the salon’s strict guidelines.
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Yes
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 Washington Board of Cosmetology and Barbers recommend social distancing of at least 6 feet.
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Yes
Have you traveled outside the United States in the past 14 days to countries that have been affected by COVID-19.
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Yes
No
Have you traveled domestically within the United States by commercial airline, bus, or train within the past 14 days.
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Yes
No
Please Enter Today's Date
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Month
-
Day
Year
Date
Please sign your full name below. By signing and submitting, this serves as a Digital Signature and verifies that you fully agree to our safety policy for our services. This digital signature holds the same authority as a handwritten one. Thank you.
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Submit
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