Consent for FACIAL Services during Covid-19 Pandemic

I understand that the novel coronavirus causes the disease known as COVID-19. I understand the novel coronavirus has a long incubation period during which the carriers of the virus may not show not show the symptoms and may still be contagious.
 
I understand that physical distancing of 6 feet may not be possible while in the salon receiving services.

I understand that I must sanitize my hands before entering Here She Glows and I must wear a mask that covers my mouth and nose while in common areas. Hard surfaces such as door handles and countertops will be wiped after each client.

 
I confirm that I am not currently positive for novel coronavirus.
 
I confirm that I am not waiting for the results of a laboratory test for the novel coronavirus.
 
I verify that I have not returned to California from any country outside of the US, whether by car, air, bus or train in the past 14 days.
 
I verify that I have not been identified as a contact of someone who has tested positive for the novel coronavirus or been asked to self-isolate by The Los Angeles  Department of Health, or any other government agency.
 
I confirm that I am not presenting with any of the following symptoms of COVID-19 indentified by the CDC
            Fever > 38C, or 100F,   chills or body aches
            Cough
            Sore Throat
            Shortness of breath
            Difficulty breathing
            Flu-like symptoms
            Runny Nose
            Loss of smell or taste

I understand that for the safety of everyone, my temperature will be check before the services are started.  

I understand that I may be unable to proceed with services at Here She Glows  if i am deemed unsafe to myself or a staff member.

I understand I may NOT bring children or anyone else who does not have an appointment into the salon.
 
I understand that Here She Glows will do everything possible to minimize the spread of COVID – 19, but will not hold them responsible should I contract the COVID – 19.
 
I will immediately notify Here She Glows if I contract the virus within two weeks following my visit.
 
I verify that the information I have provided on this form is truthful and accurate.