COVID-19 Pandemic Hair and Makeup Consent Form

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Please take a moment to complete our consent form.
By submitting the form below you agree to knowingly and willingly consenting to have hair and/or makeup service during the COVID-19 pandemic.
We reserve the right to refuse service if this form is not submitted. Thank you.

Email *

Today's Date

YYYY

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. *

Yes, I Understand

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 an elevated risk of contracting the virus simply by being in the salon. *

Yes, I Understand

No, I Do Not Understand

I confirm that I am not presenting any of the following symptoms of COVOID-19 listed: • Temperature above 98.7 degrees• Shortness of breath• Loss of sense of taste or smell• Dry cough• Sore Throat *

I Am Not Presenting Symptoms

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

Yes

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. *

Yes

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

Yes

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. *

Yes, I Understand

I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. And I understand that the CDC and New Jersey Board of Cosmetology and Barbers recommend social distancing. *

Yes, I Understand

Please type your full name below. By typing and submitting, this serves as a Digital Signature and verifies that you fully agree to our safety policy for our services. This digital signature holds the same authority as a handwritten one. Thank you. *

Rosalyn Holmes

Hair Stylist/Makeup Artist

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

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