SSL CV-19 Safe Salon Client Waiver

By completing and submitting this form, you are knowingly and willingly consenting to having beauty and or barber care services performed during the COVID-19 Pandemic and you agree to adhere to all safety and sanitation protocols now required by the salon and or shops' service provider.
If your temperature is over 99 degrees, your salon visit will be cancelled. If you take your temperature and it is 99 or above, be sure to call the salon immediately to cancel and to avoid a no show fee. Submission of your temperature is not enough notice.
Email *
Date of Service *
First Name *
Last Name *
Contact Cell/Phone Number *
My Baseline pre-visit temperature must be below 99 degree Farenheit to receive a service. Today my temperature is : *
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 . *
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. *
I confirm that none of the following COVID-19 symptoms have been present within the last 2-14 days: Fever, Shortness of Breadth, Loss of taste or smell, Dry Cough, Runny Nose, Sore Throat, Chills, Repeated Shaking with Chills, Muscle Pain or Head Ache *
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. *
I affirm that I have not traveled domestically (outside of my state) or internationally (outside of my country) within the past 14 days. *
Do you suffer from allergies *
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. *
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