LOVE CHENI The Beauty Boutique Covid-19 Waiver & Consent for Treatment

LOVE CHENI The Beauty Boutique Covid-19 Waiver & Consent for Treatment

By submitting this form, you agree to have lashes, hair, skin, or body services during the pandemic.
Client Name

First Name Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
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

Yes No
Within 14 days, have you been in contact with anyone that has COVID-19 symptoms or get infected?

Yes No
Are you living with anyone that is get infected or quarantined due to COVID-19?

Yes No
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.
Client Treatment Consent & Release

I acknowledge that beauty treatments, the practice of skin care, and the practice of advanced esthetic procedures, including, but not limited to, Lash Extensions, Keratin Lash Lifts and various other beauty procedures is not an exact science and no specific guaranties can or have been made concerning the outcome. I understand that some clients experience more change and improvement than others. In virtually all cases, multiple treatments are required in order to realize a difference.

I also understand and agree to assume the following risks and hazards which may occur in connection with any particular treatment including but not limited to: unsatisfactory results, soreness, poor healing, discomfort, redness, blistering, nerve damage, scarring, infection, change in skin pigmentation, allergic reaction, muscle damage, and increased hair growth. I understand that even though precautions may be taken in my treatment, not all risks can be known in advance.

Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treatment received, I agree to unconditionally defend, hold harmless and release from any and all liability the company and the individual that provided my treatment, the insured, and any additional insureds, as well as any officers, directors, or employees of the above companies for any condition or result, known or unknown, that may arise as a consequence of any treatment that I receive.

Upon entering Love Cheni The Beauty Boutique courtyard and studio, I acknowledge that I am aware of the risks involved from receiving treatment and I voluntarily agree to assume those risks, and I release and hold harmless Jane Nguyen and Love Cheni The Beauty Boutique from any claims related thereto. I understand and agree that any legal action of any kind related to any treatment I receive will be limited to binding arbitration using a single arbitrator agreed to by both parties. I give my consent to receive treatment from Jane Nguyen.
Guests will be required to observe the following policies:

-Masks are required for everyone upon entry to Love Cheni The Beauty Boutique
-Hand sanitizer will be readily available for guests
-Guests with appointments are only permitted to enter the courtyard & studio at their scheduled appointment time.
-Guests may not bring children or friends into the courtyard or studio unless they have a scheduled appointment.
-Guests are not permitted into the salon if they exhibit any symptoms that may be an indicator of any infection (i.e. congestion, runny nose, coughs, fevers, body aches, etc.).
-Guests are asked to reschedule their appointment for 14 days later if they have been around anyone exhibiting symptoms that may be an indicator of any infection (i.e. congestion, runny nose, coughs, fevers, body aches, etc.).
-Arriving to your appointment while exhibiting any symptoms and ignoring any of the above guidelines will lead to refusal of service and a partial payment for services, NO EXCEPTIONS

I understand that COVID-19 is a highly contagious virus that spreads from person to person. In addition to long-held and explicit sanitation measures this business has always adhered to, new preventative measures have been put in place to further reduce the spread of this novel coronavirus. However, these best practices still offer no guarantee regarding your potential risk of being infected.

I understand it is my responsibility to inform Jane Nguyen if any possible symptoms of Covid-19 arise within 24 hours of any of my appointments.

I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. Upon entering Love Cheni The Beauty Boutique courtyard and studio, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless Jane Nguyen and Love Cheni The Beauty Boutique from any claims related thereto. I give my consent to receive treatment from Jane Nguyen.
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