AR SALON WAVIER- COVID-19
AR Salon is required to document all appointments and clients receiving services.
Masks are mandatory to receive services.
Please contact me before entering if you would like to purchase a disposable mask.
Name
*
First Name
Last Name
Phone Number
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Format: (000) 000-0000.
Email
*
Date of appointment
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 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
1
2
AM
PM
AM/PM Option
Select the service you are receiving by Ashleigh Raynor Cooper.
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Please Select
Blowout
Haircut
Color
Highlights
Brazilian Blowout
Hair Extensions
Other chemical service
I understand the Governors orders state no one with a fever or symptoms of COVID-19, or known exposure to a COVID-19 case in the prior 14 days, is permitted in the establishment unless properly tested for COVID-19 with a negative result after being exposed.
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by checking this box I understand and accept this statement and have not been exposed nor had any symptoms in the past 14 days or was recently tested for COVID-19 and received a negative result.
by checking this box I disagree with this statement and/or have been exposed and/or had symptoms within the past 14 days and understand I will not be able to receive services at this time.
I understand I must wear a mask covering my nose and mouth entering the building and for the duration of my appointment. Masks are mandatory.
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Agree by checking this box I understand and accept this statement.
by checking this box I disagree with this statement and understand I will not be able to receive services at this time.
I knowingly and willingly consent to having hair and salon service(s) at Ashleigh Raynor LLC during the COVID-19 pandemic.
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by checking this box I understand and accept this statement.
by checking this box I disagree with this statement and understand I will not be able to receive services at this time.
To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the salon's strict guidelines.
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by checking this box I understand and accept this statement.
by checking this box I disagree with this statement and understand I will not be able to receive services at this time.
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. I know that the CDC, OSHA, and Virginia state board of cosmetology recommend social distancing of at least 6 feet.
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Agree by checking this box I understand and accept this statement.
by checking this box I disagree with this statement and understand I will not be able to receive services at this time.
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of hair services, that I have elevated the risk of contracting the virus by merely being in the salon company.
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Agree by checking this box I understand and accept this statement.
by checking this box I disagree with this statement and understand I will not be able to receive services at this time.
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.
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Agree by checking this box I understand and accept this statement.
by checking this box I disagree with this statement and understand I will not be able to receive services at this time.
I am willing to take a temperature check during my visit to the salon before the services are started, and I agree not to come to the salon with the following symptoms of COVID-19 listed below: Fever- Temperature, Shortness of breath, Loss of sense of taste or smell, Dry cough, Runny nose and Sore throat.
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Agree by checking this box I understand and accept this statement.
by checking this box I disagree with this statement and understand I will not be able to receive services at this time.
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 provide the best possible guest experience when visiting ASHLEIGH RAYNOR SALON.
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Agree by checking this box I understand and accept this statement.
by checking this box I disagree with this statement and understand I will not be able to receive services at this time.
Parent or Guardian of minor
First Name
Last Name
Signature
*
Submit
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