JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 Pandemic Nail Service Consent Form
GLOSS NAIL BAR 1211 N EUCLID ST, ANAHEIM, CA 92801
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
I knowingly and willingly consent to having nails and waxing service(s) during the COVID-19 pandemic.
*
by checking this I understand and accept this statement.
To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow Gloss Nail Bar's guidelines.
*
by checking this I understand and accept this statement.
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of nail services, that I have elevated the risk of contracting the virus by merely being in the salon.
*
by checking this I understand and accept this statement.
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 give the current limits in virus testing.
*
by checking this I understand and accept this statement.
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.
by checking this I understand and accept this statement.
Clear selection
I agree not to come inside the salon with the following symptoms of COVID-19 listed below: Fever, High Body Temperature, Shortness of breath, Loss of sense of taste or smell, Dry cough, Runny nose, or Sore throat.
*
by checking this I understand and accept this statement.
I understand, read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to ensure the safety of our community and to provide the best possible guest experience when visiting Gloss Nail Bar.
*
by checking this I understand and accept this statement.
Signature
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report