COVID-19 Questionnaire & Liability Relea

COVID-19 Questionnaire & Liability Release Form

Due to the 2019-2020 outbreak of COVID-19, we are taking extra precautions with the intake of each client. Our main goal is to protect our staff and our clients as much as possible. New safety protocols are being implemented by our facility: frequent disinfection and cleaning, minimal contact, keeping 6 ft. distance whenever possible. Our business and technicians are taking all precautions to keep you safe during this time.

We ask that you help keep yourself and us safe by reviewing and completing the following form:

Symptoms of the novel coronavirus include (but not limited to):

Fever
Dry Cough
Sore Throat
Muscle Pain
Headache
Fatigue
Chills
Difficulty Breathing (advanced cases)
Loss of Taste or Smell

Please initial the following:

I have not experienced, or been in contact with anyone, who has any of the above symptoms in the last 14 days.

To the best of my knowledge, I, or any members of my household, have not come in contact with anyone who has been exposed to COVID -19 within the last 30 days.

To the best of my knowledge, I, or any members of my household, have not contracted or come in contact with anyone who has had a confirmed case of COVID-19 in the last 30 days.

I, or any members of my household, have not traveled to an area where there has been a COVID-19 outbreak in the last 30 days.

When it is necessary to be out in public., I have worn an appropriate face covering and maintained a 6ft. distance between myself and others.

I understand that Naked Face Cosmetic Spa LLC and my permanent makeup technician Haley Blanding cannot be held liable for any exposure to the novel coronavirus. I understand the risk and accept the precautions the technician and their facility are taking to prevent the spread of disease. By signing below, I agree that this form has been filled out to the best of my knowledge and release all liability of any unintentional exposure of the novel coronavirus (COVID-19) from the permanent makeup technician and business listed above.

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COVID-19 Questionnaire & Liability Release Form

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