Health is a priority, please fill out.
Have you or any persons living with you
Returned from outside of the U.S in the last 14 days?
Return for a domestic COVID-19 epicenter in the last 14 days?
Been in contact with or cared for someone diagnosed with COVID-19 in the last 14 days?
Experienced any cold or flu symptoms in the last 14 days?
None of the above
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Esthetics Studio has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Esthetics Studio can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Esthetics Studio staff, and other Esthetics Studio clients and their families. I voluntarily seek services provided by Esthetics Studios and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I hereby release and agree to hold Esthetics Studio harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of Esthetics Studio, or that may otherwise arise in any way in connection with any services received from Esthetics Studio. I understand that this release discharges Esthetics Studio from any liability or claim that I, my heirs, or any personal representatives may have against Esthetics Studio with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Esthetics Studio. This liability waiver and release extends to property owners together with all Esthetics Studio owners and partners.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service