Assumption of Risk Form

Assumption of the Risk Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Client is fully aware of the current pandemic and the inherent risks involved.

PACIFIC BLEACH SALON and its owners, Amanda Reuther and Katherine Gehlbach, employees or agents (referred to here as "Hairstylist") have put in place preventative measures to reduce the spread of COVID-19; however, despite these extra measures, we cannot guarantee that you will not become exposed to COVID-19. Further, like visiting any public place, this could increase your risk of contracting COVID-19.
I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by visiting or coming into the Hairstylist’s salon, and that such exposure or infection may result in personal injury, illness, permanent disability, and/or death.
Initial
I understand that the risk of becoming exposed to or infected by COVID-19 at the Hairstylist’s salon may result from the actions, omissions, or negligence of myself and others, including, but not limited to, the Hairstylist, Hairstylist’s employees, volunteers, participants and their families.
Initial
I understand that the risk of becoming exposed to or infected by COVID-19 at the Hairstylist’s salon may result from the actions, omissions, or negligence of myself and others, including, but not limited to, the Hairstylist, Hairstylist’s employees, volunteers, participants and their families. I also understand in the event a COVID 19 exposure is confirmed by a client of Hairstylist's salon, that my name and contact may be required by public health authorities as someone who had close contact at the hairstylist's business.
Initial
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself of any kind (including, but not limited to, loss, expense, damage, illness, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance or presence at the Hairstylist’s salon and/or through the performance of Hairstylist’s services (COVID claims).
Initial
I hereby release, covenant not to sue, discharge, and hold harmless the Hairstylist, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto.
Initial
Thank you for taking the time to complete this one-time form.
- Pacific Bleach Salon

4283 Mission Blvd. Ste 2
San Diego, CA 92024
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Assumption of the Risk Relating to Coronavirus/COVID-19