CV-19 Safe Salon Client Waiver

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By completing and submitting this form, you are knowingly and willingly consenting to having beauty and or barber care services performed during the COVID-19 Pandemic and you agree to adhere to all safety and sanitation protocols now required by the salon and or shops' service provider.

Email *

First Name *

Last Name *

Contact Cell/Phone Number *

I acknowledge that anytime I am within close proximity (less than 6ft) of my service provider or any other person, I could have an elevated risk of contracting COVID-19 should it be present. *

Yes

Required

I confirm that none of the following COVID-19 symptoms have been present within the last 2-14 days: Fever, Shortness of Breath, Loss of taste or smell, Dry Cough, Runny Nose, Sore Throat, Chills, Repeated Shaking with Chills, Muscle Pain or Head Ache *

None of the above

Required

I affirm that I have not been exposed to anyone that has been diagnosed with COVID-19 within the past 14 days. *

I Affirm

Required

I affirm that I have not traveled domestically (outside of my state) or internationally (outside of my country) within the past 14 days. *

I Affirm

Required

I agree by providing my name below, I am in essence rendering my signature in acknowledgement of the completed statements on this form and that all information is accurate as of the date of this form. *

Submit

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