COVID - 19 Liability Waiver
This form must be completed & signed in order to receive ANY services by Dallas Merkley or her team.
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Email *
Full Name *
Date Of Service *
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Phone Number *
Address *
I knowingly and willingly consent to receive hair, makeup or other salon services during the COVID-19 pandemic. *
Required
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. *
Required
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. I know that the CDC, OSHA, and Oregon state board of cosmetology recommend social distancing of at least 6 feet. *
Required
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of hair services, that I have elevated the risk of contracting the virus by merely being in the salon company. *
Required
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 give the current limits in virus testing. *
Required
  I am NOT experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. *
Required
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 * *
Required
I confirm that I have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days * *
Required
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Dallas Merkley has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Dallas Merkley can not guarantee that I will not become infected with the Coronavirus/COVID-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families. I voluntarily seek services provided by Dallas Merkley and/or her team and acknowledge that I am increasing my risk of exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I hereby release and agree to hold Dallas Merkley and/or her team harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Dallas Merkley and/or her team. I understand that this release discharges Dallas Merkley and/or her team from any liability or claim that I, my heirs, or any personal representatives may have against the salon/business with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Dallas Merkley and/or her team. This liability waiver and release extends to the salon together with all owners, partners, and employees. *
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