Jasmine goddard

1

Name* This field is required.

First Name

Last Name

2

Date* This field is required.

Date

3

You must
•Wait in your car till your appointment time.
•Sanitize before each appointment as you enter the store.
•Masks are available for use.
•Please don’t bring other people to your appointments.
Thank you for doing your part in keeping our spa a safe and healthy place.

4

To prevent the spread of contagious viruses and to help protect each other, I understand that i will have to follow the strict guidelines* This field is required.

by checking this box I understand and accept this statement.

5

I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of spa services, that I have elevated the risk of contracting the virus by merely being in the business .* This field is required.

by checking this box I understand and accept this statement.

6

I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it, and who does not give the current limits in virus testing.* This field is required.

by checking this box I understand and accept this statement.

7

I verify that I have not traveled outside of England In the past 14 days to countries that have been affected by COVID-19* This field is required.

YES

NO

8

I confirm that I have or have not traveled domestically within England by commercial airline, bus or train within the past 14 days* This field is required.

YES

NO

9

I agree not to come to cocola with the following symptoms of COVID-19 listed below: Fever- Temperature Shortness of breath Loss of sense of taste or smell Dry cough Runny nose Sore throat

Yes

10

I understand, read, 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 Renew spa

Yes

11

Signature* This field is required.