Covid-19 Waxing Boutique Waiver Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have dry cough?
Yes
No
Do you have fever?
Yes
No
Are you experiencing shortness of breath?
Yes
No
Are you experiencing loss of smell?
Yes
No
Are you experiencing loss of taste?
Yes
No
Have you traveled recently within the last 14 days internationally?
Yes
No
Do you have someone at home who tested positive to Covid-19?
Yes
No
Waiver
I will abide by the strict Covid-19 spread out prevention protocols the premise is implementing.
I am releasing the Waxing Boutique company from any liabilities and claims in case of exposure to Covid-19.
I confirmed that all information I entered in this form is accurate and true.
I have read and fully understand the above, am over eighteen years of age, and am legally liable for my own decisions or actions.
By signing below, it means that I agreed to the terms indicated in this document.
Client Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: