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Salon U
17 E Flint Street
Lake Orion, MI 48363
248-693-8768
salon_u.com

Please read and sign the below consent form PRIOR TO coming to your appointment. Please read each question and section thoroughly and sign twice. If you do not feel comfortable answering the below personal health questions please reach out to your stylist immediately.

I CERTIFY THAT I HAVE NOT EXPERIENCED THE FOLLOWING SYMPTOMS IN THE LAST TWO WEEKS:

  • Fever of 99 degrees or higher or chills
  • Cough
  • Loss of taste or smell
  • Chest Pains or shortness of breath
  • Nausea or vomiting
  • Fatigue or body aches
  • Sore throat
  • Congestion or runny nose
  • Upset stomach

I ALSO CERTIFY THAT I HAVE NOT:

  • Come in contact with someone who has had COVID-19 symptoms or tested positive in the last 4 weeks
  • Traveled outside of the country
  • Recently traveled outside of the State of Michigan in the past 14 days

I willingly and knowingly consent to having salon services during the COVID-19 pandemic. I understand by choosing to receive services at Salon U that I assume all the risks of contracting COVID-19 and will not hold the owner or independent stylists responsible for my health or incurred medical expenses. I have read the salon’s sanitation policy online at www.salon_u.com/covid-19 and understand that Salon U  is following all CDC and Michgain State guidelines and am comfortable receiving salon services. I understand that my information may be shared with the Public Health Department for the purposes of contact tracing if necessary. I have reviewed salon guidelines also available at www.salon_u.com/covid-19 that explain my part to keep myself and the Salon U staff safe and will adhere to those new client rules. 

Today's Date: July 4, 2020

First Participant's Name

First Name*

Last Name*
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*
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.
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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