COVID-19 Initial Client Wavier

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

Email *

First Name *

Last Name *

Phone Number *

I am aware that due to limited testing for the COVID-19, the virus has a long incubation period during which time carriers of the virus may be asymptomatic (no symptoms) and still be highly contagious. I also acknowledge that it is impossible to determine who has it . *

Yes, I am aware.

Required

I also acknowledge that I understand 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 the virus should it be present. *

Yes

Required

I confirm that none of the following COVID-19 symptoms have been present within the last 1-14 days: Fever *

Yes

Required

I confirm that none of the following COVID-19 symptoms have been present within the last 1-14 days: Shortness of Breath *

Yes

Required

I confirm that none of the following COVID-19 symptoms have been present within the last 1-14 days: Loss of taste or smell *

Yes

Required

I confirm that none of the following COVID-19 symptoms have been present within the last 1-14 days: Dry Cough *

Yes

Required

I confirm that none of the following COVID-19 symptoms have been present within the last 1-14 days: Sore Throat *

Yes

Required

I affirm that I have not been exposed to anyone that has been diagnosed with COVID-19 within the past 14 days inside or outside of the country I reside in. *

I Affirm

Other (specify)

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

Other (specify)

Required

Do you suffer from allergies? If yes, explain what are your allergy symptoms. If no, then put "Not Applicable or N/A" below. *

Select your stylist name *

Date *

YYYY

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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