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COVID 19 Health Screening:

By checking the below boxes I am attesting that I have NOT had the below symptoms or circumstances:

I am NOT currently experienceing any of the following symptoms:

I Agree

  • Cough
  • Shortness of breath or difficulty breathing
  • Fever
  • Chills
  • Muscle pain
  • Sore throat
  • New loss of taste or smell

I have NOT had more than 2 of these symptoms in the past 14 days?

I do NOT shared a home with or come in direct contact with anyone who has displayed any of these symptoms within the past 14 days?

I Agree

I have NOT been quarantined for or diagnosed with COVID-19 within the past 14 days?

I Agree

I have NOT shared a home with or come in direct contact with someone who has been quarantined for or diagnosed with COVID-19 within the past 14 days?

I Agree

 

RELEASE OF LIABILITY ANDAGREEMENT NOT TO SUE, INDEMNIFICATION, HOLD HARMLESS, LIMITATION OF WARRANTY

We all know that these are uncertain times. The risks of COVID-19 are not well understood and there is controversy among the experts on how the virus can spread and difficultly in scientifically determining whether anyone has the virus at any moment in time.

Salon and spa services cannot be conducted with the advised 6' physical distancing. I am aware of this and am willing to accept that risk.

In consideration for providing salon or spa services, by signing below you agree to accept all responsibility for the risk that you may contract COVID-19.  While we are taking your safety and that of our staff very serious, by employing new safety and sanitation initiatives, we cannot guarantee that any of these measures will completely protect you from contracting COVID-19.

I agree that if I take any steps to make a claim for damages against Gervais Salon & Day Spa, its agents, employees or any other released parties arising out of my receipt of services during my visit to Gervais’s facilities, I shall be obligated to pay all attorneys’ fees and costs incurred as a result of such claim.

By signing this Agreement, I acknowledge that I am free to go to other salons who may not require my agreement to accept responsibility for contracting COVID-19 and I chose to have salon or spa services. 

 

First Guest's Name

First Name*

Last Name*
First Guest's Date of Birth*
I certify that I am 18 years of age or older
First Guest's Signature*
Second Guest's Name

First Name*

Last Name*
Second Guest's Date of Birth*
Third Guest's Name

First Name*

Last Name*
Third Guest's Date of Birth*
Fourth Guest's Name

First Name*

Last Name*
Fourth Guest's Date of Birth*
Fifth Guest's Name

First Name*

Last Name*
Fifth Guest's Date of Birth*
Sixth Guest's Name

First Name*

Last Name*
Sixth Guest's Date of Birth*
Seventh Guest's Name

First Name*

Last Name*
Seventh Guest's Date of Birth*
Eighth Guest's Name

First Name*

Last Name*
Eighth Guest's Date of Birth*
Ninth Guest's Name

First Name*

Last Name*
Ninth Guest's Date of Birth*
Tenth Guest's Name

First Name*

Last Name*
Tenth Guest's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
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*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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