Citizen Salon COVID-19 Hair Service Consent Form
*This form must be completed prior to performing any services at Citizen Salon.*
Thank you for you patience and understanding during this time. We look forward to seeing you! Please email saloncitizen@gmail.com if you have any questions or concerns.
Email address *
I, (Client Name), knowingly and willingly consent to have my hair serviced during the COVID-19 pandemic at Citizen Salon. *Please provide your full name below* *
I confirm that I am not presenting any of the following symptoms of COVID-19 listed: Fever, shortness of breath, loss of sense of taste of smell, dry cough, runny nose, sore throat and other symptoms noted by the CDC. *
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. I understand that the CDC, OSHA and California Board of Cosmetology and Barbers recommend social distancing of at least 6 feet to protect against the CORVID-19 virus, and that by receiving treatments I will not maintain a 6 foot social distance. *
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. *
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 COVID-19 and who does not have COVID-19 given the current limits in virus testing. *
I understand due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of the hair service received, that I have an elevated risk of contracting the virus simply by being in a salon and by choosing to enter, accept that risk. *
• 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. I verify that I have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days. *
Electronic Signature *
Today's Date *
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