Consent Waiver
COVID-19 Pandemic Salon/Spa Treatment Consent Form. Please complete & submit this form before your scheduled appointment.
By signing your name you consent to knowingly and willingly have service(s) during the COVID-19 pandemic.
First Name
Last Name
Email
example@example.com
I understand the COVID-19 virus has a long incubating 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.
Agree
Disagree
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.
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Please Select
Agree
Disagree
I confirm that I am not presenting any of the following symptoms of COVID-19: Temperature above 98.7, shortness of breath, loss of sense of taste or smell, dry cough or, sore throat.
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Please Select
Agree
Disagree
I confirm that if I present symptoms between now and my appointment that I will cancel. I also understand that I can be denied service if I show up with symptoms.
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Please Select
Agree
Disagree
I confirm that I have not been around anyone with these symptoms in the past 14 days.
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Please Select
Agree
Disagree
I do not live with anyone who is sick or quarantined.
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Please Select
Agree
Disagree
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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Please Select
Agree
Disagree
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 "STATE" Board of Cosmetology and Barbers recommend social distancing of at least 6 feet.
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Please Select
Agree
Disagree
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.
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Please Select
Agree
Disagree
I verify that I have not traveled domestically within the United States by commercial airline, bus, or train within the past 14 days.
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Agree
Disagree
I confirm that New_Salon and Professional_Name are released from any liability related to Covid-19.
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Please Select
Agree
Disagree
Today's date, confirming you have read & answered the above truthfully and understand that you will have to follow the salon’s strict guidelines upon your appointment.
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Month
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Day
Year
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Comments:
CONFIRM
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