EXQUISITE BITS (for your fingertips) Covid-19 Nail Salon Services Consent Form

EXQUISITE BITS (for your fingertips) Covid-19 Nail Salon Services Consent Form

By submitting this form, you agree to have your nails (hands and/or feet) services carried out during the pandemic.
Client Name

Full NameEmail
Client Details

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

I understand that I have a risk of contracting the 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.
Parent/Guardian Name (if applicable)

Full NamePhone Number
Date

MonthDayYear
Date
Client/Parent/Guardian Signature

Clear
Should be Empty: