Lauren Jeong Esthetics Covid-19 Services Consent Form

Client Name

First NameLast Name

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

I understand that I have a risk of contracting virus during the service.I 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. I hereby release and agree to hold Lauren Jeong Esthetics 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 Lauren Jeong Esthetics. I understand that this release discharges Lauren Jeong Esthetics 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 Lauren Jeong Esthetics. This liability waiver and release extends to the salon together with all owners, partners, and employees.

Parent/Guardian Name (if applicable)

First NameLast Name

Date

Client/Parent/Guardian Signature