Covid-19 Suites Services Consent Form
By submitting this form, you agree to have hair, skin, or body services with GLAROINE.
Client Name
First Name
Last Name
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.
Parent/Guardian Name (if applicable)
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Client/Parent/Guardian Signature
Submit
Should be Empty: