Therapy Salon, LLC
COVID-19 Client Waiver Form

The new normal (for now)

          Therapy Salon LLC, 

         COVID-19 Updates, Protocols & Waiver. We want to share with you some of the adjustments that we’ve had to make to our salon operations. This is out of an abundance of caution for our staff, our guests and our community. We’ve made many internal changes to our salon procedures but we wanted to share the ones that will affect you at your visit.

  • We have set up an entry station for sanitation and communication upon arrival. 
  • We ask you that you bring in minimal belongings to your appointment. (example: keys, wallet, phone). 
  • Please come to your appointment alone. NO additional guests or children at your appointment
  • Temperature checks will be taken upon check in. In the interest of keeping our staff and other customers safe, No one with a fever will receive services.
  • We ask that you arrive at your scheduled appointment time and no sooner. Our waiting area will remain closed. 
  • If you prefer to stay in your car until your service provider is ready, we are happy to text when it is time to come in. We will also do our best to notify you should your stylist be running behind. Due to the extra time required to sanitize stations between clients there is a chance of being 15 minutes behind by the end of the day. 
  • All team members and guests MUST WEAR MASKS. NO EXCEPTION. We can provide you one if needed. Do not remove your mask during your visit 
  • We will NOT be having you change into color robes please wear an older T-shirt or something that has a lower neckline. We will be using styling capes as usual (which are always washed in between uses).
  • Guests will be seated at every other station and 8 feet apart in the lounge. 
  • We will not be offering beverages at this time, NO AVEDA TEA
  • Temporarily suspending some complimentary services; NO hand massage, These protocols will continue to be refined and adjusted as needed and will keep you informed very step of the way. 
  • Please confirm your appointments when you receive your reminders so we know you are coming. We have many clients wanting to get in. It will help tremendously to know if there will be an available spot on our books. If you do not confirm 24 hours prior to your appointment time your will lose your appointment. There is a 50% charge for cancellations made less then 24 hours in advance and 100% charge for no shows
  • No-show Cancellation Policy- We will not be penalizing for any last-minute cancellations due to BEING SICK. However, please provide us with information as soon as possible so we can adjust our schedules accordingly. We are trying our best to get every client back in as soon as possible. 
  • Payment – We will only accept Credit Cards for payment.
  • Waiver- Must be completed & submitted before Appointment. Please read the following waiver, fill in the form below and click the submit button below to agree to the terms of the waiver. 

In-salon Temperature Policy 

I’m willing to take a temperature check during my visit to the salon before the services are started, and I agree not to come to the salon with eh following symptoms of COVID-19 listed below:

  • fever 
  • temperature,
  • shortness of breath
  • loss of sense of taste and smell
  • dry cough 
  • runny rose 
  • sore throat
  • At any time during our contact with you, if we feel you are not complying with the rules stated above, show signs of illness or are in any way combative we reserve the right to refuse service and will ask you to leave immediately. 

By signing below, you agree to comply with the written instructions above. Failure to comply with these written instructions or verbal instructions from staff may result in your removal from the premises. 

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.

I further acknowledge that Therapy Salon has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families.

I voluntarily seek services provided by Therapy Salon and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.

I attest that:

 I am not experiencing any symptom of illness such as

  • Cough
  • Shortness of breath or difficulty breathing
  •  Fever, chills, repeated shaking with chills 
  • Muscle pain 
  • Headache
  •  Sore throat
  •  New loss of taste or smell
  • I have not traveled internationally within the last 14 days
  • I have not traveled to a highly impacted area within the United States of America in the last 14 days.
  • I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19
  • I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities

I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

I hereby release and agree to hold Therapy Salon harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Therapy Salon. I understand that this release discharges Therapy Salon from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Therapy Salon. This liability waiver and release extends to the salon together with all owners, partners, and employees.

I have read, agree and comply with the instructions stated above. I’m ready to look and feel great! 

Date: October 24, 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


Confirm Email*
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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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