Wellness Screening- Ember Salon, Boulder
New Guidelines Effective 5/9/2020 for services at Ember Salon
Name *
Date *
MM
/
DD
/
YYYY
Address of client *
E-mail Address *
Temperature Reading *
Do you have any of the following symptoms? *
Required
Details of Service *
Required
Service Provider *
Required
I have reviewed and understand the safety procedures implemented by Ember Salon as precautions to protect against the spread of COVID-19. I also understand that Ember Salon cannot guarantee the effectiveness of such steps in preventing any customer, employee, or other visitor from contracting COVID-19. I knowingly assume the risk of contracting COVID-19 by using Ember Salon services and waive any and all claims against Ember associated with the transmission of COVID-19. *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy