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COVID-19 Informed Consent & Liability Waiver

Brows LLC

dba Brows On Upper 15th 

2542 15th Street 

Denver, Colorado

80211

COVID-19 is a highly contagious virus that spreads from person to person. In addition to long-held and explicit sanitation measures this business has always adhered to, new preventative measures have been put in place to further reduce the spread of this novel coronavirus. However, these best practices still offer no guarantee regarding your potential risk of being infected.

Consent for Treatment
I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner and Brows, LLC  from any claims related thereto. I give my consent to receive treatment and/or purchase products from this practitioner and Brows LLC.  I agree to follow safety guidlines and requests from staff as a condition of my service, and understand that I may be asked to exit the building, or proceed to an isolation area if Brows LLC staff determines that an unsafe situation has arisen.

 

 

 

First Visitor's Name

First Name*

Middle Name

Last Name*

Phone*
First Visitor's Date of Birth*
First Visitor's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
First Visitor's Signature*
Second Visitor's Name

First Name*

Middle Name

Last Name*

Phone*
Second Visitor's Date of Birth*
Second Visitor's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
Second Visitor's Signature*
Third Visitor's Name

First Name*

Middle Name

Last Name*

Phone*
Third Visitor's Date of Birth*
Third Visitor's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
Third Visitor's Signature*
Fourth Visitor's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Visitor's Date of Birth*
Fourth Visitor's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
Fourth Visitor's Signature*
Fifth Visitor's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Visitor's Date of Birth*
Fifth Visitor's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
Fifth Visitor's Signature*
Sixth Visitor's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Visitor's Date of Birth*
Sixth Visitor's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
Sixth Visitor's Signature*
Seventh Visitor's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Visitor's Date of Birth*
Seventh Visitor's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
Seventh Visitor's Signature*
Eighth Visitor's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Visitor's Date of Birth*
Eighth Visitor's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
Eighth Visitor's Signature*
Ninth Visitor's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Visitor's Date of Birth*
Ninth Visitor's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
Ninth Visitor's Signature*
Tenth Visitor's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Visitor's Date of Birth*
Tenth Visitor's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
Tenth Visitor's Signature*
Visitor's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information and Consent
I agree and consent to any of the following, on site body temperature check, symptom screening, and agree to reschedule my appointment 14 days later if any corona virus symptoms flag for me.*
No
Yes
I understand Brows offers a no penalty cancellation policy and agree to stay home if I feel the slightest bit sick.*
No
Yes
I understand that only the visitor receiving the service may enter the building at the arranged time, that Brows can not accommodate waiting children or extra visitors at this time. If a minor is also receiving a service, I will make sure they agree to these COVID-19 avoiding measures.*
No
Yes
I agree to wear a cloth mask to enter Brows, and must leave it in place, covering nose and mouth during the entire visit. I understand that no services that require visitor or employee to move their mask can be performed.*
No
Yes
I agree to practice 6 foot social distancing from all other people during my visit, with the only exceptions being the duration of the service being provided. I understand that Brows will not be able to provide a waiting area, accept walk in appointments, or allow lines to form. Please contact our front desk when you arrive in the area to arrange entry time.*
No
Yes
I agree to practice meticulous hand hygiene while I am visiting, to arrive with recently washed hair, face, and hands. I will help keep the new low touch culture of Brows, and take advantage of frequent hand washing and hand sanitizing.*
No
Yes
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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