Precautionary Coronavirus Liability Release Form

  • Precautionary Coronavirus Liability Release Form

    Precautionary Coronavirus Liability Release Form
  • Date*
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  • Date of Birth*
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  • Gender

  • Due to the outbreak of the novel COVID-19, Clean Slate Spa is taking extra precautions with the intake of each client, health history review as well as sanitation and disinfecting practices. 

    Symptoms of COVID-19:

    • Fever
    • Fatigue
    • Dry Cough
    • Difficulty Breathing
    • Muscle Aches
    • Sore Throat
    • Loss of Taste and Smell
  • I agree to the following:
  • I have been oriented of the following for this appointment (all must be checked):

  • By signing below, I agree to each of the above statements and release Clean Slate Spa and its owner from any and all liability for the unintentional exposure of or harm from COVID-19.

    Clean Slate Spa agrees they will also abide by these same standards and affirm the same. Clean Slate Spa also affirms the continuous improvement and expanded santitation protocols to fight the spread of COVID-19 and other communicable diseases.

  • Date Signed
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  • Clear
  • Should be Empty: