TWO ZERO ONE SALON COVID-19 FORM

TODAYS DATE

Date

TWO ZERO ONE SALON COVID-19 QUESTIONNAIRE AND WAIVER, ASSUMPTION OF RISK, AND RELEASE OF LIABILITY

The safety of our customers and employees is TWO ZERO ONE SALON'S first priority. As the COVID-19 disease outbreak continues to evolve and spread globally, TWO ZERO ONE SALON continues to monitor the situation closely. To prevent the spread of COVID-19 and reduce the risk of potential exposure to our customers and employees, TWO ZERO ONE SALON is implementing a simple screening questionnaire. All employees or customers must complete this questionnaire before entering our location. Your participation is an important part of keeping our employees and customers safe, and we thank you for your time. Any person who answers “Yes” to any of the questions below may be denied services.

Name

First Name Last Name

Phone Number

Have you traveled from a foreign country in the last 14 days?

YES NO

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?

YES NO

Have you had close contact with anyone who has traveled to a foreign country within the last 14 days?

YES NO

Have you experienced any cold or flu-like symptoms in the last 14 days (including fever, cough, sore throat, respiratory illness, difficulty breathing, or general aches and pains)?

YES NO

WAIVER, ASSUMPTION OF RISK, AND RELEASE OF LIABILITY

I, , am visiting the TWO ZERO ONE SALON, legally known as TwoZeroOne Salon LLC voluntarily. I understand that, based on information currently available, the COVID-19 virus is continuously spreading throughout the state of New Jersey, including via direct person-to-person transmission and hard surfaces. I understand that the COVID-19 virus can cause serious illness or death in individuals of all ages, with or without preexisting conditions. I acknowledge that the services I am voluntarily seeking from TwoZeroOne SALON necessarily include close contact with TwoZeroOne SALON employees, products, equipment, and other surfaces or instruments. While TwoZeroOne SALON has attempted to minimize the spread of COVID-19, I acknowledge that due to the nature of TwoZeroOne SALON’s services, it is impossible for TwoZeroOne SALON to completely eliminate the risk of COVID-19 transmission at TwoZeroOne SALON.

Notwithstanding the known and unknown risks and hazards of exposure to the COVID-19 virus, I wish to enter TwoZeroOne SALON and utilize TwoZeroOne SALON’s services. I HEREBY WAIVE ANY AND ALL CLAIMS AGAINST TwoZeroOne SALON AND ITS OWNERS, AFFILIATED ENTITIES, MEMBERS, OFFICERS, DIRECTORS, MANAGERS, EMPLOYEES, OR AGENTS (collectively, the “TwoZeroOne SALON Affiliated Parties”) FOR EXPOSURE TO OR CONTRACTION OF THE COVID-19 VIRUS, TO THE FULLEST EXTENT PERMITTED BY NEW JERSEY LAW. Should I contract or transmit the COVID-19 virus, I agree to hold harmless the TWOZEROONE SALON Affiliated Parties from any costs, expenses or damages which I incur. I understand that this release applies to any injury or damages I may suffer in connection with COVID-19, even if caused by the acts or omissions of others OR RESULTING FROM THE NEGLIGENCE OF ANY TWOZEROONE SALON AFFILIATED PARTY.

I confirm that I have read the foregoing and voluntarily assume all risks of exposure to or contraction of the COVID-19 virus in connection with entering TWOZEROONE SALON and utilizing TWOZEROONE SALON’s services. I UNDERSTAND THAT THIS IS A LEGAL DOCUMENT AND THAT BY SIGNING IT I AM GIVING UP MY RIGHT TO SUE OR OTHERWISE MAKE ANY CLAIM against any and all of the TWOZEROONE SALON Affiliated Parties. In addition, by signing my name below, I certify that the answers provided to the above survey questions are true and accurate.

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Two Zero One Salon