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Waiver

Dear Clients,

We want to sincerely thank you for your patience during this challenging time. Due to the ongoing situation of COVID-19, Glowout is taking extra precautions to make sure our clients, staff, and community stay healthy and safe. As a salon, we will continue to follow the guidelines recommended by the CDC and the Illinois Department of Health to avoid transmission of the coronavirus. In order to maximize the safety of our stylists and clients, we are taking the following measures:

 

All stylists will wear masks and gloves.
All clients will be required to wear masks (cloth masks, including bandanas are acceptable).
Please arrive at the time of your appointment. Do not arrive too early or too late. 
Please come alone to your appointment. Unless you are a parent or guardian of a minor who has an appointment, or a caretaker for another individual who requires support, we ask that you bring no other guests or children to minimize unnecessary exposure. 
We have reduced and staggered our appointment volume and will potentially do so thereafter to allow for physical distancing to the extent possible.
Make sure you have a credit card on file. We will not be accepting cash or checks. With a card on file, we do not need your card in hand. This will make check-out hands free for our clients and team.
All clients will be asked to complete screening representations and a waiver and liability release form before their appointments for any at risk histories or symptoms.
All clients will be asked the same screening questions when they arrive for their appointments.
We have expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 

 

These protocols will continue to be refined and adjusted as needed and we will keep you informed of any changes. 

 

The below waiver and liability release form must be completed prior to your appointment. We will not allow clients to keep their appointments if the waiver and liability release form has not been completed. 

 

Please read the following waiver, fill in the form below, and click the submit button below to agree to the terms of the waiver.

 

 

COVID-19 Waiver and Liability Release Form

 

Due to the outbreak of the novel Coronavirus COVID-19, Glowout Salon is taking extra precautions with the intake of each client, including a health history review. Please complete the following and sign below. 

 

Symptoms of COVID-19 include:

-Fever

- Chills

- Cough

- Headaches 

- Loss of taste

- Loss of smell

-Fatigue

-Difficulty breathing

 

I,

 represent, warrant, and agree to the following:

 

-I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days. 

-I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the last 30 days.

-I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.

-I affirm that I as well as all household members, have not traveled outside the US or to any city outside of Chicago that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days.

-I understand that Glowout Salons and my stylist cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.

 

By signing below (i) I agree that each representations above is true and accurate; (ii) I agree that I am visiting the salon at my own risk; and (iii) I release Glowout Salons and my stylist from any and all liability relating to COVID-19.

 

Glowout Salons and all the employees within the team agree that they abide by these same standards and affirm the same. 

First Client's Name

First Name*

Middle Name

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
First Client's Signature*
Second Client's Name

First Name*

Middle Name

Last Name*

Phone*
Second Client's Date of Birth*
Second Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Third Client's Name

First Name*

Middle Name

Last Name*

Phone*
Third Client's Date of Birth*
Third Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Fourth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Client's Date of Birth*
Fourth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Fifth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Client's Date of Birth*
Fifth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Sixth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Client's Date of Birth*
Sixth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Seventh Client's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Client's Date of Birth*
Seventh Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Eighth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Client's Date of Birth*
Eighth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Ninth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Client's Date of Birth*
Ninth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Tenth Client's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Client's Date of Birth*
Tenth Client's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

How did you hear about us? *

What is your reason for tanning today? *
Skin Type: *
Dry
Normal
Combination
Oily
Acneic

A few details about your skin routine & any issues you may have: *
Are you exfoliated with a mild, non oily cleanser?*
No
Yes
Do you have any makeup, deodorant or perfume on your skin?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Exercise level: *
Daily
2-3 days a week
Once a week
Rarely

Any particular areas of dryness? (Hands, feet, elbows, knees etc.) *
Are any of the following areas a concern?
Allergies/nut allergies
Asthma/respiratory issues
History of dizziness/fainting
Recent illness
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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