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The Parlour by Dollhouse COVID - 19 Consent Form 

 

May 28, 2020

 

I knowingly and willingly consent to have salon service(s) performed at The Parlour by Dollhouse during the COVID-19 pandemic.

I Agree

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

I Agree

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

I Agree

I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of services performed at The Parlour by Dollhouse, that I have elevated the risk of contracting the virus by merely being in the salon company.

I Agree

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

I Agree

I have not been around anyone who has been sick or tested positive for COVID-19 in the last 14 days

I Agree

I or someone in my household is not currently pending COVID-19 test results

I Agree

I’m understand and allow my temperature to be check prior to my appointment at The Parlour by Dollhouse.  I agree not to move forward with my appointment today if I have experiencing the following symptoms of COVID-19:

*Fever     *Shortness of breath     *Loss of sense of taste or smell     *Dry cough     *Runny nose     *Sore throat.

I am fully knowledgeable of the new terms that have been put in place for the safety of myself and the stylists at The Parlour by Dollhouse. I understand that the stylist or salon will not be held accountable for any sickness that may occur after my appointment. The Parlour by Dollhouse has taken proper precautions and informed me how Covid-19 can be contacted from person to person. I am fully aware and agree to allow my stylist to perform services on me.

I Agree

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 stylists at The Parlour by Dollhouse

I Agree

 

 

 

First Guests Name

First Name*

Last Name*

Phone*
First Guests Date of Birth*
I certify that I am 18 years of age or older
First Guests Signature*
Second Guests Name

First Name*

Last Name*
Second Guests Date of Birth*
Third Guests Name

First Name*

Last Name*
Third Guests Date of Birth*
Fourth Guests Name

First Name*

Last Name*
Fourth Guests Date of Birth*
Fifth Guests Name

First Name*

Last Name*
Fifth Guests Date of Birth*
Sixth Guests Name

First Name*

Last Name*
Sixth Guests Date of Birth*
Seventh Guests Name

First Name*

Last Name*
Seventh Guests Date of Birth*
Eighth Guests Name

First Name*

Last Name*
Eighth Guests Date of Birth*
Ninth Guests Name

First Name*

Last Name*
Ninth Guests Date of Birth*
Tenth Guests Name

First Name*

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

Email*

Confirm Email*
Who is your stylist performing services today?
Please select your stylist*
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*

Phone*
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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