Covid-19 Release Form

Name *

First

Last

I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not, given the current limits in virus testing. *

I agree

I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of hair services, that I have an elevated risk of contracting the virus simply by being in the salon. *

I agree

I confirm that I do not have any of the following symptoms of COVOID-19 listed below: * *

I do not have a temperature above 100 degrees

I do not have shortness of breath

(copy) *

I do not have loss of sense of taste or smell

(copy) (copy) *

I do not have a dry cough

I do not have sore throat

I confirm that I have not been around anyone with these symptoms in the past 14 days. * *

Yes

I do not live with anyone who is sick or quarantined. *

I Do Not

To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the salon’s strict guidelines. *

Yes

I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. And I understand that the CDC, OSHA and Texas Board of Cosmetology and Barbers recommend social distancing of at least 6 feet. *

Yes

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. *

Yes

I verify that I have not traveled domestically within the United States by commercial airline, bus, or train within the past 14 days. *

Yes

Signature *

By signing and submitting, this serves as a digital signature and verifies that you fully agree to our safety policy for our services.

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