COVID-19 Pandemic K. Louise Boutique Salon Consent Form
Name
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First Name
Last Name
Email
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example@example.com
Date
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-
Month
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Day
Year
Date Picker Icon
Name of Stylist for upcoming visit
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Please Select
Kara
Kelly
Marisa
Name of stylists
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First Name
I understand the risks associated with visiting a hair salon during a pandemic and understand it is solely my decision to have services done at K.Louise Boutique Salon. If I am exposed to or contract Covid19 or any other illness while visiting K.Louise Boutique Salon I understand that K Louise Boutique Salon or it's employees are under no liability.
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by checking this box I understand and accept the above statement.
I understand I am to come to my appointment alone, and call the salon from my car when I have arrived.
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by checking this box I understand and accept the above statement.
I understand that I may not bring any food,drink or personal items with me into the salon.
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by checking this box I understand and accept the above statement.
I understand I must wear a mask completely covering my nose and mouth for the duration of my appointment.
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by checking this box I understand and accept the above statement.
I understand with any color service (with the exception demi permanent) I must arrive to my appointment with clean blow dried hair.
By checking this box I understand and expect the above statement.
I verify that I have checked and will comply with the current Pennsylvania travel restrictions, as well as the current restrictions for any other state I may have recently visited, or be traveling from prior to my visit to K. Louise Boutique Salon.
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by checking this box I understand and accept the above statement, even if I am a PA resident.
I confirm I do not live with or care for some who has flu like symptoms or been diagnosed with Covid19 in the last 14 days.
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Yes
No
I understand that K. Louise Boutique Salon has the right to refuse service to any guest that appears to be ill or does not comply with our policy.
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By checking this box I understand and accept the above statement.
In-salon Symptoms Policy
I agree not to come to the salon with the following symptoms of COVID-19 listed below: Fever, Shortness of breath Loss of sense of taste or smell Cough, Runny nose or Sore throat. If I do Feel sick, I will cancel my appointment. I understand I will NOT be charged a cancellation fee show even if it is a last minute cancelation for illness or exposure to illness.
I have read, understood, 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 K. Louise Boutique Salon
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Yes
Signature
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Submit
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