Covid-19 Tanning Waiver Form

Health Measures Questionnaire

	Yes	No
Did you recently travel internationally during the last 14 days?	1	2
Do you have a fever within the last 24 hrs?	3	4
Did you recently travel internationally during the last 14 days?	5	6
Are you experiencing chills?	7	8
Do you have a sore throat?	9	10
Do you have muscle pain?	11	12
Do you have shortness of breathing?	13	14
Have you lost your sense of smell and taste?	15	16
Are you experiencing some headaches?	17	18

If your answer has 2 yes's then we apologize, the ABC Tanning Salon cannot perform the procedure that you requested. You will be advised to self-isolate for 10 days and consult with a physician.
Name
First NameLast Name
Gender
MaleFemale
Age
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Parent/Guardian Name (If client is 18 years old and below)
First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Waiver & Release
I completely fathom that going to a closed space will give me a higher risk of contracting COVID 19.

I affirm that COVID 19 does not show symptoms until 10 days or more, tracing the source is highly improbable since this is a public space, and customers' are coming in and out of the premise for the procedure that they requested.
I release the ABC Tanning Salon from any liabilities, claims, legal pursuit coming from me in the event I contracted COVID 19 virus.
Client Signature
Clear
Date Signed
MonthDayYear
Date
Manager of ABC Tanning Salon
First NameLast Name
Manager of ABC Tanning Salon Signature
Clear
Date Signed
MonthDayYear
Date
Should be Empty:

Waiver & Release