Covid-19 Salon Services Consent Form

Covid-19 Salon Services Consent Form

By submitting this form, you agree to have hair removal, skin, or body services during the pandemic.
Client Name

First NameLast Name
By checking the boxes, you confirm that you agree with the following statements:

I agree I have not been in contact with anyone that is confirmed positive for Codid-19I agree to obey the rules of the salon during my appointment in order to minimize the spread of viruses.I confirm that I have not been diagnosed with COVID-19 last 14 days.I verify that I am not waiting for the laboratory test results for COVID-19.
Do you have any of these symptoms? - cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste/smell

YesNo
Within 14 days, have you been in contact with anyone that has COVID-19 symptoms or get infected?

YesNo
Are you living with anyone that is get infected or quarantined due to COVID-19?

YesNo
I agree not to visit the salon for any of the services provided if I have the symptoms of COVID-19. I acknowledge that the information I have given in this consent form is accurate and complete. By signing below, I confirm that I understand and agree to all terms and statements in this form.
Parent/Guardian Name (if applicable)

First NameLast Name
Date

MonthDayYear
Date
Client/Parent/Guardian Signature

Clear
Should be Empty: