Client Profile Form

This form must be completed by each client obtaining services in your party.
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Birthdate

Month Day Year
Date
Phone Number *

Area Code Phone Number
E-mail *
How did you hear about us? *
Other
Let your friend get credit by inputting their name
Are you pregnant? *

Yes No
Are you diabetic? *

Yes No
Do you have any pets? *

Dog Cat None
Please list any known skin conditions or allergies that you may have. *
On your hands and feet do you have: Open Wounds, Cuts, Sores or Bruises? *
List and explain or write no
In what area will the services be performed? (For example: patio, living room, conference room, basement, rooftop, club room, friends house: mention friends name)
List services requested
List (3) dates for future service: (This does not confirm your booking request, when the date becomes available you will be contacted with the booking link)
Are you booking with or part of a group? *

No Yes (enter host name below)
I attest that: (select all that apply)

I have provided accurate and current information on this form and answered all medical and health-re- lated questions truthfully and completely. My signature also certifies that I understand that ManiPlease Inc reserves the right to deny service to any client due to a health condition he or she has that may pose a potential risk to practitioners or other clients, including those that pose a risk of potential contamination to service equipment. Furthermore, signing below verifies that I understand that I am responsible for informing ManiPlease Inc and/or its manicure and pedicure technicians of ANY and ALL changes to my health condition as regards to any question on this form or any potential public health risk that may arise from any change in my health condition. I Consent to Treatment of Minor: By signature below, I hereby authorize ManiPlease Inc and it’s contractors to administer service(s) to my child or dependent as they deem necessary. I hereby grant and authorize ManiPlease Inc and its contractors and employees the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of me to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I waive my right to any compensation. I understand and agree that these materials shall become the property of ManiPlease Inc and will not be returned. I hereby hold harmless, and release ManiPlease Inc and its agents and employees from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.
Signature

Clear
COVID-19 Liability Release Waiver

**Signature Required Prior to Service* This form must be completed by each client obtaining services in your party and should not be completed more than 14 days prior to service.
Due to the outbreak of the novel Coronavirus (COVID-19), ManiPlease is doing everything we can to protect our clients, our community and our nail technicians. To this extent, ManiPlease will be following the Center of Disease-Control (CDC) and the Barbicide Health and Public Safety guidance with regard to social distancing practices and sanitation. We ask that our clients disclose their health history and continue to implement these sanitation and disinfection procedures.

Symptoms of COVID-19 include:
- Fever
- Fatique
- Dry Cough
- Difficulty Breathing
*Leaving any box unchecked may result in cancelation of booking or denial of booking request. I agree to the following: *

I, nor members of my household, have not experienced any of the symptoms listed above within the last 14 days. I, nor members of my household, have not travelled internationally in the last 30 days. I, nor members of my household, have not traveled to a highly impacted area within the United States of America is the last 30 days. I, nor members of my household, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus (COVID-19). I, nor members of my household, have not been diagnosed with the Coronavirus (COVID-19) within the last 30 days. ManiPlease cannot be held liable from any exposure to the Coronavirus (COVID-19) caused by misinformation on this form or the health history provided by each client. If I take any steps to make a claim for damages against ManiPlease, its agents, employees, contractors or any other released parties, I shall be obligated to pay all attorney’s fees and costs incurred as a result of such claim.
ManiPlease is following these enhanced procedures to prevent the spread of the Coronavirus (COVID-19)

-All clients must wear a surgical mask during the duration of the service or service will be denied.

-No more than 2 members receiving service should be allowed in the service area.

-Each client is required to wash their hands priot to the start of services.

-All nail technicians will thoroughly clean clients’ hands before service.

-All equipment used during treatment will be cleaned, sterilized, and disinfected.

-All surfaces will be thoroughly cleaned with hospital grade disinfectant before and after each client, according to the manufacturer’s directions.
By signing below, I hereby release and agree to hold ManiPlease 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 damages 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 ManiPlease. I agree to release ManiPlease from any and all liability for the unintentional exposure or harm due to the Coronavirus (COVID-19).

ManiPlease agrees to abide by these standards and affirms the same.
Date *

Month Day Year
Date
Signature

Clear
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

COVID-19 Liability Release Waiver