Aurelio Salon Wellness Form
2225 Highway 9
Howell NJ 07731 732-303-0052
First and Last Name *
Email *
I knowingly and willingly consent to have hair service(s) during Covid-19 Pandemic and release Aurelio Salon of any and all responsibility and liability in connection to the Covid-19 Pandemic . *
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, given the current limits in virus testing. *
I understand that due to the frequency of visits of other client, 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.
Clear selection
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.
Clear selection
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.
Clear selection
I do not have a cough
Clear selection
I do not have a fever of 99.0 degrees now or in the past 21 days
Clear selection
I have not come in contact with any confirmed COVID-19 positive patients in the last 14 days
Clear selection
I do not have shortness of breath or difficulty breathing
Clear selection
I do not have flu-like symptoms, including gastrointestinal upset, headache, or fatigue
Clear selection
I have not had recent loss of taste or smell
Clear selection
I do not have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders
Clear selection
I understand that due to increased PPE requirements for team and all guests along with the extra sanitation times, and the 50% capacity restriction the salon had a price increase on services.
Clear selection
I ACKNOWLEDGE THAT IF I HAD ANSWERED NO TO ANY OF THE QUESTIONS I WILL CANCEL AND RESCHEDULE MY APPOINTMENT
Clear selection
BY TYPING MY NAME BELOW, I hereby acknowledge and attest that I have read, understand, and acknowledge Aurelio Salon Salon COVID-19 pandemic policy presented above, and hereby confirm, that the information I have provided above is fully true and accurate. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy