DUSTED BEAUTY | Client Consent Form

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Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

Email *

FIRST NAME *

LAST NAME *

PHONE NUMBER *

DATE *

YYYY

PLEASE CHECK ALL THAT APPLY: *

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

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 in virus testing.

I confirm that I am not presenting any of the following symptoms of COVID-19 listed: temperature above 98.7 degrees, shortness of breath, loss of sense of taste or smell, dry cough, and sore throat.

I confirm that I have not been around anyone with these symptoms in the past 14 days.

I do not live with anyone who is sick or quarantined.

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.

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

I understand that the CDC, OSHA and Board of Cosmetology and Barbers recommend social distancing of at least 6 feet. The salon reserves the right to reschedule any clients that have flown 14 days prior to their appointment.

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.

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

Required

SIGNATURE (Type Full Name) *

With this signature, I do not hold DUSTED BEAUTY or its employees liable for any damages and agree to the terms and conditions. *

I agree

Required

Waiver and Terms

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

DUSTED BEAUTY has put in place preventative measures to reduce the spread of COVID-19; however, we cannot guarantee that you will not become infected with COVID-19. Further, coming into our establishment could increase your risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by entering this establishment and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at DUSTED BEAUTY may result from the actions, omissions, or negligence of myself and others, including, but not limited to, stylists, other clients, and/or delivery services, (i,e UPS, USPS, FEDEX).

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any exposure to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or may experience or incur in connection with my appointment at DUSTED BEAUTY.

On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless DUSTED BEAUTY, its independent contractors and owners, of and from any claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating there to. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of DUSTED BEAUTY, its employees, independent contractors and owners, whether a COVID-19 infection occurs before, during, or after any appointment at DUSTED BEAUTY.

By clicking the "Submit" button below, you are consenting to signing this Document electronically. You agree your electronic signature ("E-Signature") is the legal equivalent of your manual signature on this Document. You consent to be legally bound by this Document's agreement(s), acknowledgement(s), policy(ies), disclosure(s), consent term(s) and condition(s). You agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You may request a paper version of an electronic record by writing to us. We reserve the right to charge a reasonable fee for the production and mailing of a paper version of the record. Your current valid email is required for all communications.

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