Consent Form - COVID 19 Pandemic

Consent Form - COVID 19 Pandemic
By submitting this form, you agree to have Men’s Grooming Services done during the pandemic.
First Name
Last Name
Phone:
Zip Code:
By initialing, you confirm that you agree with the following statements:
I agree to follow the rules of the establishment during my appointment in order to minimize the spread of
I confirm that I have not been diagnosed with COVID-19 in the last 14 days.I verify that I am not waiting for laboratory test results for COVID-19.I voluntarily seek services provided by Springfield Sport Barbershop LLC and acknowledge that I am increasing my
Risk of exposure to the Coronavirus/COVID-19.
I’m willing to take a temperature check during my visit to the salon before the services are started.
Do you have any of these symptoms? - cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste/smell Within 14 days, have you been in contact with anyone that has COVID-19 symptoms or get infected?
YN
Are you living with anyone that is get infected or quarantined due to COVID-19? Did you recently travel (within 14 days from your appointment date) outside New Jersey to those states that required self-quarantine by the State's order? 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.
Date:
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Date
Client Signature:
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