COVID-19 Pandemic Nail treatment Consent Form
TIPS AND TOES SALON LLC
1405 W Capitol Dr, Unit O
Pewaukee, WI 53072
Email address *
Enter your name to confirm that you have read and agree to this statement. *
I, ____cw__, knowingly and willingly consent to have nail treatment during the COVID-19 pandemic.
Enter your initials to confirm that you have read and agree to this statement.
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.
Enter your initials to confirm that you have read and agree to this statement. *
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of nail treatments, that I have an elevated risk of contracting the virus simply by being in a salon.
Enter your initials to confirm that you have read and agree to this statement.
I understand that Tips And Toes Salon has put in place preventative measures, however, cannot guarantee that me or my family will be become infected with COVID-19. I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that me or my family may be exposed to or infected by COVID-19
Enter your initials to confirm that you have read and agree to this statement.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my family or myself (including, but not limited to, personal injury, disability), illness, damage, loss, claim, liability, or expense, of any kind, that I or my family may experience or incur in connection with my family coming into Tips and Toes Salon.
Enter your initials to confirm that you have read and agree to this statement.
On my behalf, and on behalf of my family, I hereby release, covenant not to sue, discharge, and hold harmless to the salon, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto.
Enter your initials to confirm that you have read and agree to this statement.
I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Salon, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in the Salon.
Check the boxes to confirm that you are not presenting any of the following symptoms. Enter your initials IN "OTHER" to confirm that you have read and agree to this statement. *
I confirm that I am not presenting any of the following symptoms of COVID-19 listed below:
Required
Enter your initials to confirm that you have read and agree to this statement. *
To prevent the spread of contagious viruses to help protect each other, I understand that I will have to follow the salon’s strict guidelines.
Enter your initials IN "OTHER" to confirm that you have read and agree to this statement. *
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. And I understand that the CDC, OSHA and Wisconsin Board of Cosmetology and Barbers recommend social distancing of at least 6 feet.
Required
Enter your initials IN "OTHER" to confirm that you have read and agree to this statement. *
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
Enter your name. *
Enter today's date. *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy