COVID-19 Pandemic Spa Consent Form
Jacklyn Rose Skin Care
Name
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First Name
Last Name
Date
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Month
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Day
Year
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Name of Esthetician for upcoming visit
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Jacklyn
Shannon
Name of stylists
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First Name
I knowingly and willingly consent to having spa service(s) during the COVID-19 pandemic.
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by checking this box I understand and accept this statement.
To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the spa's strict guidelines.
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by checking this box I understand and accept this statement.
I agree not to come to the salon with the following symptoms of COVID-19 listed below: Fever- Temperature Shortness of breath Loss of sense of taste or smell Dry cough Runny nose Sore throat
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by checking this box I understand and accept this statement.
I verify that I have not traveled outside the United States In the past 14 days to countries that have been affected by COVID-19
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YES
NO
I hereby release and agree to hold Jacklyn Rose Skin Care harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Jacklyn Rose Skin Care. I understand that this release discharges Jacklyn Rose Skin Care from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Jacklyn Rose Skin Care. This liability waiver and release extends to the spa together with all owners, partners, and employees.
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by checking this box I understand and accept this statement.
In-Spa Temperature Policy
I’m willing to take a temperature check during my visit to the spa before the services are started, and I agree not to come to the spa with the following symptoms of COVID-19 listed below: Fever- Temperature Shortness of breath Loss of sense of taste or smell Dry cough Runny nose Sore throat
I understand, read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to provide the best possible guest experience when visiting Jacklyn Rose Skin Care.
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Yes
Signature
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