Name*

First Name Last Name

Date*

Month Day Year

You must
•wait in your car till your appointment time
•please wear your shoes through the store to the spa entrance and place on shoe rack (try to wear socks)
•sanitize before each appointment as you enter the store
•masks are available for use
•washrooms are for emergencies only
•please don’t bring other people to your appointments
Thank you for doing your part in keeping our spa a safe and healthy place :)

To prevent the spread of contagious viruses and to help protect each other, I understand that i will have to follow the strict guidelines*

by checking this box I understand and accept this statement.

I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of spa services, that I have elevated the risk of contracting the virus by merely being in the business .*

by checking this box I understand and accept this statement.

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.*

by checking this box I understand and accept this statement.

I verify that I have not traveled outside of Canada In the past 14 days to countries that have been affected by COVID-19*

YES NO

I confirm that I have or have not traveled domestically within Canada by commercial airline, bus or train within the past 14 days*

YES NO

I confirm that I have or have not traveled domestically within Canada by commercial airline, bus or train within the past 14 days*

Yes

I agree not to come to the spa 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 Sore throat

Yes

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 Renew spa

Yes

Signature*

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COVID-19 Consent Form