Therapy Salon, LLC
COVID-19 Client Waiver Form

The new normal (for now)

To our valued clients,    

Prior to entering Therapy Salon we want to share our COVID-19 protocols and adjustments we have instilled to our daily operations. This is out of an abundance of caution for our staff, guests and community. We have made many changes to our salon’s operations and procedures and want to ensure your compliance to these requirements before your arrival.


  • It is mandatory for team members and guests to WEAR MASKS. NO EXCEPTION.
    • We can provide you one if needed. Do not remove your mask during your visit.
  • Before entry temperature checks will be taken. 100.4 F or below.
  • Upon entry there is a sanitation and communication station. 
  • Minimize personal belongings to only what is necessary. 
    • (example: keys, wallet, phone). 
  • Come to your appointment alone. NO additional guests or children at your appointment. 
  • Arrive at the salon during your scheduled time. Our waiting area will remain closed, so please wait in your car until then.
    •  If your stylist is running behind we will do our best to notify you as soon as possible. Due to the extra time required to sanitize it is possible this may occur. 
  • We will NOT provide color robes for your appointment. Please come to your appointment with an older T-shirt of something with 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. 
  • Please confirm your appointments. We have many clients on our waiting list…
    • No-show Cancellation Policy- 
      • We will not be penalizing for any last-minute cancellations due to BEING SICK. PLEASE, notify us as soon as possible so we can adjust our schedules accordingly.
      • If you do not confirm 24 hours prior to your appointment time you will lose your appointment AND 100% charge for no shows. 
      • There is a 50% charge for cancellations made less than 24 hours in advance
  • 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. 


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 COVID-19 waiver, 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, agreed and complied with all the instructions stated above. I’m ready to look and feel great! 

Date: July 24, 2021 


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*
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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