COVID-19 Client Safe Salon Waiver
This form is to be used as record for clients of Good Hair Day Salon employees, independent contractors or sole proprietors conducting business at Good Hair Day Salon to ensure that during the COVID-19 Pandemic, there are no symptomatic signs of the virus.
Email address *
First Name *
Your answer
Last Name *
Your answer
Contact Cell/Phone Number *
Your answer
What day is your appointment?(Please complete this form within 48 hours of your appointment. Forms signed sooner than 2 days of the appointment will need to be resigned.) *
MM
/
DD
/
YYYY
Which stylist is your appointment scheduled with? *
My Baseline pre-visit temperature must be below 99 degree Farenheit to receive a service. Today my temperature is : *
Your answer
I am aware that due to limited testing for the COVID-19, the virus has a long incubation period during which time carriers of the virus may be asymptomatic (no symptoms) and still be highly contagious. I also acknowledge that it is impossible to determine who has it . *
Required
I also acknowledge that I understand that anytime I am within close proximity (less than 6ft) of my service provider or any other person, I could have an elevated risk of contracting the virus should it be present. *
Required
I confirm that none of the following COVID-19 symptoms have been present within the last 2-14 days: Fever, Shortness of Breath, Loss of taste or smell, Dry Cough, Runny Nose, Sore Throat, Chills, Repeated Shaking with Chills, Muscle Pain or Head Ache *
Required
I affirm that I have not been exposed to anyone that has been diagnosed with COVID-19 within the past 14 days inside or outside of the country I reside in. *
Required
I affirm that I have not traveled domestically (outside of my state) or internationally (outside of my country) within the past 14 days. *
Required
Do you suffer from allergies *
Upon arrival to your appointment 1. Please text your stylist or call the salon when you have arrived. You will be prompted when to come inside. No waiting in the lobby. 2. You must wear a mask for the duration of your appointment. Your stylist will provide a mask if you don't have one. 3. Your temperature will be checked upon entry. 4. Do not bring additional guests. 5. You must wash your hands. 6. Do not bring food or drinks. 7. Minimize your personal belongings. For a complete list of policies, visit www.goodhairday.net. *
Required
I agree by providing my name below, I am in essence rendering my signature in acknowledgement of the completed statements on this form and that all information is accurate as of the date of this form. Type your name below: *
Your answer
Today’s Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy