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Go Bare Inc.

Coronavirus Liability Release Form

Due to the 2019-2020 outbreak of the novel Coronavirus, COVID-19, Go Bare Inc. d/b/a Go Bare Spa & Skin Clinic is taking extra precautions with the intake of each client and its sanitation and disinfecting practices.  The employees of Go Bare Inc. have completed this form as well and are abiding by the same standards and representations set forth herein.  Go Bare Inc. has improved and expanded its sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.

Please complete the following and sign below.    

Symptoms of COVID-19 include:

Fever

Fatigue

Dry cough

Difficulty breathing

Loss of sense of smell and taste

Muscle or body aches

Go Bare requires that if you are experiencing any of these symptoms, you reschedule your appointment so as not to expose the staff or other clients.

I, 

 agree to the following:

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

 

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

 

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

 

I Agree
  I understand that Go Bare Inc. and my aesthetician 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 other clients.

By signing below, I agree to each above statement and release and hold harmless Go Bare Inc. and its employees from any and all liability for the unintentional exposure or harm due to COVID-19.

 

First Participant's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
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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