COVID-19 Liability Waiver

COVID-19 Hair Services Consent Form
Date*

MonthDayYear
Date
Name*

First NameLast Name
I knowingly and willingly consent to receive hair and salon service(s) from SWANK Beautique during the COVID-19 pandemic.*

By checking this box, I understand and accept this statement.
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.*

By checking this box, I understand and accept this statement
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. I know that the CDC, OSHA, and South Carolina's State Board of Cosmetology recommend social distancing of at least 6 feet.*

By checking this box, I understand and accept this statement
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 elevated the risk of contracting the virus by merely being in the salon facilities.*

By checking this box, I understand and accept this statement
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 give the current limits in virus testing.*

By checking this box, I understand and accept this statement
I verify that I have not traveled outside the United States in the past 14 days to countries that have been affected by COVID-19.*

By checking this box, I understand and accept this statement
I confirm that I have or have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days.*

By checking this box, I understand and accept this statement
I confirm that I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.*

By checking this box, I understand and accept this statement
I attest that I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.*

By checking this box, I understand and accept this statement
I attest that I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities.*

By checking this box, I understand and accept this statement
I attest that I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.*

By checking this box, I understand and accept this statement
In-salon Agreement & Temperature Check

*I hereby release and agree to hold SWANK Beautique harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from SWANK Beautique. I understand that this release discharges SWANK Beautique from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from SWANK Beautique. This liability waiver and release extends to the salon together with all owners, partners, and employees.

*I’m willing to take a temperature check during my visit to the salon before the services are started, and I agree not to come to the salon with the following symptoms of COVID-19 listed below:
- Fever- Temperature
- Shortness of breath
- Loss of taste or smell
- Dry cough
- Runny nose
- Sore throat
I am fully knowledgeable of the new terms that have been put in place for the safety of myself and my stylist, Ange Culbertson. I understand that the stylist will not be held accountable for any sickness that may occur after my appointment. Ange Culbertson has taken proper precautions & informed me how Covid-19 can be contacted from person to person. I am fully aware & still will allow her to perform services by signing this contract.*

I agree
I understand, read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to provide the best possible guest experience when visiting Stylist Ange Culbertson.*

I agree
Signature*

Clear
Should be Empty: