Covid-19 Nail Salon Services Consent Form

Client Name

First NameLast Name

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

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?

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

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.

By signing below, you confirm that you have provided accurate and current information on this form. I affirm that I have made this consent and waiver voluntarily. In any case that I decide to withdraw or revoke my waiver, I may do do by submitting a written request signed by me to the salon company.

Client's Signature

First NameLast Name

Date

Client/Parent/Guardian Signature