JARGM COVID-19 Liability Form

COVID-19 Liability Release Waiver

**Thank you for taking the time to fill out this pre-appointment health check before your appointment. Please keep in mind it is a requirement for this form to be completed prior to every scheduled appointment**
Due to the 2019-2020 outbreak of the Coronavirus (COVID-19), Just A Really Good Manicure is taking extra precautions with the care of every guest to include a health history review and enhanced sanitation/disinfection procedures in accordance with the Local, State and CDC guidelines. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19: Fever or Chills, Cough, Shortness of breath or difficulty breathing, Fatigue, Muscle or body aches, Headache, New loss of taste or smell, Sore throat, Congestion or runny nose, Nausea or vomiting, Diarrhea *This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19.
I agree to the following:*

I understand the above symptoms and affirm that I, as well as all household members, do NOT currently have, nor have experienced the symptoms listed above WITHIN THE LAST 14 DAYS.I affirm that I, as well as all household members, have NOT been diagnosed with COVID-19 WITHIN THE PAST 14 DAYS.I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 14 DAYS.I affirm that I, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 14 DAYS.I waive all liability of Just A Really Good Manicure if I unavoidable contract COVID-19.I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of eyelash extension services, that I have elevated the risk of contracting the virus by being in a public setting, such as this location and accept that risk.I understand the COVID-19 virus has a long incubation period, during which carriers of the virus may not show any symptoms and still be highly contagious. It is impossible to fully determine who is positive and who is not, given the current limits of screening in this location and I accept the risk.
Just A Really Good Manicure is following these enhanced procedures to prevent the spread of COVID-19: Additional time included between appointments to sanitize service areas and to minimize guest contact. Everyone in the space must be masked. Guests receiving services must wear a mask or face shield that covers the nose and mouth completely at all times. Each guest is required to sanatize hands upon arrival. Each guest will have a designated area for belongings. Please try to avoid bringing belongings inside as the surfaces of purses, wallets, etc could hold bacteria for days. Only the very necessities. Your Nail Technician will thoroughly wash and sanitize hands as often as possible. Like normal, all surfaces will be wiped thoroughly with hospital grade disinfectant before and after each client. By signing below, I agree to each statement above and release from any and all liability for the unintentional exposure or harm due to COVID-19. DeNi Lash agrees to abide by these standards and affirms the same.
Name*

First NameLast Name
Cell phone *

Area CodePhone Number
Email
example@example.com
Date*

MonthDayYear
Date
Signature *

Clear
I confirm all of the above information to be true and agree to all terms and guidelines as listed above, and my agreement is in alternate of my signature.*

I agree and sign.
Should be Empty:

COVID-19 Liability Release Waiver