Mojo Barbershop COVID 19 INTAKE FORM & WAIVER
Please complete this form before your appointment.
Due to the outbreak of COVID-19, Mojo Barbershop is doing everything we can to protect you, our clients, our community and our staff. Mojo Barbershop has implemented safety measures and procedures in accordance with CDC and OSHA guidelines for social distancing and sanitation. We ask you to disclose the following information to help our community control the spread of COVID-19. Thank you for your cooperation.
Email address *
First and Last Name *
Phone number *
I affirm that I, as well as my household members DO NOT currently have, nor have experienced symptoms of COVID-19 or illness (fever, cough, sneezing, shortness of breath, fatigue, muscle ache, new loss of taste or smell, nausea or diarrhea) in that past 30 days. *
I affirm that I, as well as my household members HAVE NOT been diagnosed with COVID-19 within the past 60 days. *
I affirm that I, as well as my household members HAVE NOT traveled out of the state in the past 14 days. *
I understand and answered these questions honestly. By signing you release Mojo Barbershop and all staff members from any and all liability for the unintentional exposure or harm due to COVID-19. *
Required
First and Last Name *
Today's Date *
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Time *
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