COVID-19 Pandemic Tattoo Consent Form
Ashley Antolin Tattoos and Art
Name
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First Name
Last Name
Date
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Month
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Day
Year
Date Picker Icon
Name of Tattoo Artist for upcoming Visit
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Ashley Antolin
I knowingly and willingly consent to having tattoo service(s) during the COVID-19 pandemic.
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By checking this box I understand and accept this statement.
To prevent the spread of contagious viruses and to help protect each other, I understand that i will have to follow the tattoo shops strict guidelines
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By checking this box I understand and accept this statement.
I understand that the Tattoo Shop requires proper medical grade masks in shop and social distancing is enforced and encouraged.
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By checking this box I understand and accept this statement.
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. I know that the CDC and OSHA recommend social distancing of at least 6 feet.
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By checking this box I understand and accept this statement.
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of tattoo services, that I have elevated the risk of contracting the virus by merely being in the salon company.
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By checking this box I understand and accept this statement.
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.
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By checking this box I understand and accept this statement.
I verify that I have not traveled outside the United States In the past 14 days to countries that have been affected by COVID-19
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YES
NO
I confirm that I have or have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days
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YES
NO
Tattoo Shop Symptoms Policy
I agree not to come to the Tattoo Shop if I have tested positive for COVID-19 or with the following symptoms of COVID-19 listed below: Fever - high temperature, shortness of breath, loss of sense of taste or smell, dry cough, runny nose, sore throat or any other unmentioned symptoms related to COVID-19.
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 Everett Tattoo Emporium
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Yes
Signature
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