COVID-19 PANDEMIC HAIR TREATMENT CONSENT FORM

• I knowingly and willingly consent to having hair and salon service(s) during the COVID-19 pandemic
    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 salon's strict guidelines. *
    by checking this box I understand and accept this statement
• 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 elevated the risk of contracting the virus by merely being in the salon company. *
    by checking this box I understand and accept this statement
• 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 give the current limits in virus testing.
    by checking this box I understand and accept this statement
• I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. I know that the CDC, OSHA, and the Maryland state board of cosmetology recommend social distancing of at least 6 feet.,09 *
    by checking this box I understand and accept this statement
• I confirm that I am not presenting any of the following symptoms of COVOID-19 listed below:
  • Temperature above 100.4 degrees
  • Shortness of breath
  • Loss of sense of taste or smell
  • Dry cough
  • Sore Throat

  YOUR TEMPERATURE WILL BE CHECKED UPON ENTRY.
    by checking this box I understand and accept this statement

• I do not live with anyone who is sick or quarantined
    by checking this box I understand and accept this statement
• I do not live with anyone who is sick or quarantined.
  Yes     No  
• 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     No  
• I confirm that I have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days *
  Yes     No  
• 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 the salon
    by checking this box I understand and accept this statement

WAIVER AND RELEASE

I hereby waive all claims and forever release the E and E Hair Solutions, including its officers, directors, employees, successors, assigns, agents, heirs, representatives, and volunteers as applicable, in their individual or corporate capacities, of all claims, liabilities, agreements, and causes of action of any nature due to any injury, loss, or damage to person or property, that may arise out of my services performed at the Salon.
By signing below, I agree to the above statements and release E and E Hair Solutions, Evie Johnson, its officers, staff and practitioners from any and all liability for the unintentional exposure or harm due to COVID-19.


Signature *

Date *

ADDITIONAL GUIDELINES

The Salon and my stylists are following these enhanced procedures to prevent the spread of COVID-19:

• Additional time included between appointments to sanitize service areas and to minimize guest contact.
• Increased distance between clients to adhere to safe social distancing guidelines.
• No visitors during your service.
• Each guest is required to wash or sanitize hands upon arrival.
• Your service provider will thoroughly wash and sanitize hands as often as possible.
• Guests receiving services must wear a mask or face shield that covers the nose and mouth completely.
• All surfaces and restrooms will be wiped thoroughly with hospital grade disinfectant before and after each client.
• Routine temperature Checks of Staff and Clients.
• Everyone in the space must be masked.

By signing below, I agree to each statement above and release from any and all liability for the unintentional exposure or harm due to COVID-19. The Salon and my stylist agree to abide by these standards and affirms the same.


Signature *

Date *



Email *