Client Name

First Name Last Name

By checking the boxes, you confirm that you agree with the following statements:

I understand that I have a risk of contracting virus during the service. I agree to obey the rules of the salon during my appointment in order to minimize the spread of viruses. I confirm that I have not been diagnosed with COVID-19 last 14 days. I verify that I am not waiting for test results for COVID-19.

Do you have any of these symptoms? - cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste/smell

Yes No

Within 14 days, have you been in contact with anyone that has COVID-19 symptoms or get infected?

Yes No

Are you living with anyone that is get infected or quarantined due to COVID-19?

Yes No

I agree not to visit the salon for any of the services provided if I have the symptoms of COVID-19. I acknowledge that the information I have given in this consent form is accurate and complete. By signing below, I confirm that I understand and agree to all terms and statements in this form.

Parent/Guardian Name (if applicable)

First Name Last Name

Client/Parent/Guardian Signature

Clear

Covid-19 Salon Services Consent Form