Chi Wah Organica COVID-19 Service Waiver

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Our Priority is Safety, Sanitation and Wellness.

Email *

Guest Name

Date of your Appointment

YYYY

What best describes how you feel about your upcoming salon visit?

I'm looking forward to the "Chi Wah Organica Experience"

I'm excited but I want to spend as little time as possible in public

Other:

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SALON SERVICE PRE-SCREEN QUESTIONS

HAVE YOU BEEN IN CLOSE CONTACT WITH ANY PERSON DIAGNOSED (confirmed by testing) WITH THE COVID-19 VIRUS IN THE LAST 14 DAYS?

YES

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HAVE YOU BEEN AROUND ANYONE THAT HAS HAD A FEVER, COUGH, SORE THROAT, MUSCLE ACHES OR SHORTNESS OF BREATH IN THE LAST 14 DAYS?

Yes

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ARE YOU EXPERIENCING SEVERE ACUTE LOWER RESPIRATORY ILLNESS (cough, shortness of breath) AND A FEVER?

Yes

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I UNDERSTAND THAT IN ORDER TO RECEIVE A SALON SERVICE THAT I MUST WEAR A FACE MASK.

I AGREE

CONSENT FORM

I knowingly and willingly consent to have hair treatments during the COVID-19 pandemic. (initial)

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 given the current limits on virus testing. (initial)

I understand that due to the frequency of visits of other clients, the characteristics of the virus, that I have an elevated risk of contracting the virus simply by being in a salon. (initial)

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. (initial)

I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. And 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. (initial)

I verify that I have not traveled domestically within the United States by commercial airline, bus, or train within the past 14 days. (initial)

GUEST LIABILITY RELEASE

RELEASE OF LIABILITY AND AGREEMENT NOT TO SUE, INDEMNIFICATION, HOLD HARMLESS, LIMITATION OF WARRANTY.

We all know that these are uncertain times. The risks of COVID-19 are not well understood. In consideration for providing haircuts and color, by signing below you agree to accept all responsibility for the risk that you may contract COVID-19. While we are taking your safety and that of our staff very serious, by employing new safety and sanitation initiatives, we cannot guarantee that any of these measures will completely protect you from contracting COVID-19.

I agree that if I take any steps to make a claim for damages against Chi Wah Organica, its agents, employees or any other released parties arising out of my receipt of haircut or color services during my visit to Chi Wah Organica's facility, I shall be obligated to pay all attorney's fees and costs incurred as a result of such claim.

I acknowledge that I can go elsewhere to have my haircut and color and I acknowledge that Chi Wah Organica is not the only hair salon where I can go to get my services. By signing this agreement, I acknowledge that I am free to go to other salons who may not require my agreement to accept responsibility for contracting COVID-19 and I chose to have my services with them.

CHI WAH ORGANICA RESERVES THE RIGHT TO TURN AWAY ANY GUEST THAT VISIBLIY PRESENTS SYMPTOMS AS DESCRIBED ABOVE OR THAT HAS CHECKED YES TO ANY OF THE ABOVE QUESTIONS.

IN ADDITION, THE CHI WAH ORGANICA TEAM IS SCREENED DAILY AT ARRIVAL UTILIZING THE ABOVE PROTOCOLS. ANYONE ANSWERING YES OR EXHIBITING SYMPTOMS WILL NOT BE ALLOWED INSIDE THE BUILDING OR AT WORK UTIL THEY TEST NEGATIVE FOR COVID-19 OR ARE SYMPTOM FREE.

If we all work together, we can overcome the spread of this virus as well as other infectious diseases. We welcome you to our home. By signing below, you agree to comply with the written instructions above. Failure to comply with these written instructions or verbal instructions from staff or volunteers may result in your removal from the premises.

NAME AND DATE

A copy of your responses will be emailed to the address you provided.

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