Covid-19 Waiver

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If you are experiencing any flu like or even allergy like symptoms, please reach out to me asap to reschedule for the safety of staff and patrons.
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1. Have you traveled by plane or ship or been in close contact with anyone who has traveled within the last 14 days? * This field is required.
YESNO
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2. Have you had close contact with or cared for someone diagnosed with COVID- 19 within the last 14 days? * This field is required.
YESNO
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3. Have you experienced any cold or flu-like symptoms in the last 14 days (fever 99.0 or higher, cough, shortness of breath or other respiratory problem)? * This field is required.
YESNO
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Visitors answering YES to any of the above questions will not be permitted access to MalCole Drip and Beauty Bar, LLC ("MalCole")’s facility. Appointment will be rescheduled to a later date. I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that MalCole has put in place preventative measures to reduce the spread of the Coronavirus/COVI D-19. I further acknowledge that MalCole cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others. I voluntarily seek services provided by MalCole and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
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I attest that:* This field is required.
I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
I have not traveled internationally within the last 14 days.
I have not traveled to a highly impacted area within the United States of America in the last 14 days.
I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as noncontagious by state or local public health authorities.
I am following all CDC recommended guidelines as much as possible and limiting my exposure to Coronavirus or COVID-19.
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Name* This field is required.
First Name
Last Name
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Signature* This field is required.I release and agree to hold MalCole 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 damage 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 MalCole. I understand that this release discharges MalCole from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from MalCole. This liability waiver and release extends to the clinic together with all owners, partners, and employees.
Clear
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Date* This field is required.
Date
Year
Month
Day
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