Nicole rudolph
First Name
Last Name
Name
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Franny
Gaspari
4EVER NAILS & SPA COVID-19 Pandemic
Service Log & Consent Form *GUIDELINES BY CDC*
4/24/21
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Month
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Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Nicolerudolph23@gmail.com
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example@example.com
6105743693
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Please 6107166337enter a valid phone number.
COVID-19 RELATED QUESTIONS
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YES
NO
TRAVELED OUTSIDE THE U.S WITHIN THE PAST 14 DAYS.
TRAVELED DOMESTICALLY WITHIN U.S BY COMMERCIAL AIRLINE, BUS OR TRAIN WITHIN THE PAST 14 DAYS.
SYMPTOMS OF COVID-19: FEVER TEMPERTURE, SHORTNESS OF BREATH, LOSS OF SENSE OF TASTE OR SMELL, COUGH, SORE THROAT.
NAME OF TECHNICIAN YOU VISIT:
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Please Select
TAMMY
CINDY
LISA
KIM
ANNA
PHOEBE
JENNIFER
NOT SUREc
To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the salon's strict guidelines
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by checking this box I understand and accept this statement.
I knowingly and willingly consent to having salon service(s) during the COVID-19 pandemic.
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by checking this box I understand and accept this statement.
Fg
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Submit
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