COVID-19 Form

Bare Skin Beauty Lounge
COVID-19 Information & Liability Waiver
Client Name:
Have you had a fever in the last 24 hours of 100°F or above?
3. Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus type symptoms?
Other
Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?
I understand the state of Illinois requires all persons to wear a face covering inside a place of business and when social distancing is not a possibility.
I understand that this business and my service provider cannot be held liable for any exposure to the virus or any other contagion.
I understand guests and children are not allowed.
I affirm that I have not been exposed to anyone that has been diagnosed with COVID-19 (to my knowledge) within 14 days of my appointment & if I have, I will cancel/reschedule my appointment for 30 days out.
I acknowledge 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.
COVID-19 is a highly contagious virus that spreads from person to person. In addition to long-held and explicit sanitation measures this business has always adhered to, new preventative measures have been put in place to further reduce the spread of this novel coronavirus. However, these best practices still offer no guarantee regarding your potential risk of being infected.
Consent for Treatment
I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner.
By signing below, I verify that I have read and understand the above statements and agree to them.
Client Signature:
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Parent or Guardian Signature (in case of a minor):
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2 digit month, 2 digit day, 4 digit yearDate
By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable. By electronically signing and submitting this agreement, I 1) acknowledge that I have read and fully understand the terms of the agreement; 2) voluntarily agree to be bound by this agreement; and 3) certify that I am 18 years of age or older. My signature applies to all pages of this contract. I understand that I will receive a Portable Document Format (PDF) version of this agreement after it is signed at the email address I have provided. To view the PDF document, I understand that I will need software that enables me to receive and access PDF files such as Adobe Reader software or other software capable of reading a PDF file. In order to print and retain a hard copy of this agreement, I understand that I will also need a printer connected to my computer. I understand that if I wish to sign a hard copy of this agreement instead of an electronic version, I must contact the party that requires my signature on this agreement directly.
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Bare Skin Beauty Lounge

Consent for Treatment