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 in 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 Coronavirus (COVID-19)
within the last 30 days.
Holistic Skincare by Alelie cannot be held liable for any exposure to the Coronavirus
(COVID-19) caused by misinformation on this form or the health history provided by each client.
By signing below, I hereby release and agree to hold Holistic Skincare by Alelie 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 Holistic Skincare by Alelie, or that may otherwise arise in any way in connection with any services received from Holistic Skincare by Alelie. I agree to release Holistic Skincare by Alelie from any and all liability for the unintentional exposure or harm due to the Coronavirus (COVID-19).