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Release of liability for Covid 19

Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), The Naked Peach Waxing Boutique is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfection procedures in accordance with the Pennsylvania Health Code Regulations.

 

Symptoms of COVID-19 include:

 

Fever

Fatigue

Dry Cough

Difficulty Breathing

 

I agree to the following:

 

I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above WITHIN THE LAST 14 DAYS.

 

I affirm that I, as well as all household members, have not been diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.

 

I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.

 

I affirm that I, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 DAYS.

I understand that The Naked Peach Waxing Boutique cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.

I understand that I am required to wear a mask upon entering the salon, and required to wear the mask during the time I am at The Naked Peach Waxing Boutique Salons. If I refuse to wear a mask, I will be asked to leave and there will be a full charge for the cost of my appointment. If I am unable to wear a mask due to a health condition, I might be asked to reschedule during another time. There are masks available if I need, or I may wear my own.

 

The Naked Peach Waxing Boutique is following these enhanced procedures to prevent the spread of COVID-19.

 

Additional time included between appointments to prevent client contact with each other.

 

Guests accompanying those scheduled for services is no longer offered, and no children are permitted during appointments.

 

Each client is required to wear a mask

 

Each client required to sanitize hands upon arrival and before leaving

 

Your service provider will thoroughly clean hands and wear new gloves during all treatments

 

Your service provider will wear a clean cloth mask and/or a face shield.

 

All surfaces will be wiped thoroughly with hospital grade disinfectant before and after each client according to the manufacturer's directions.

 

Social distancing is required and clients may be asked to wait outside or in their car.

 

By signing below, I agree to each statement above and release The Naked Peach Waxing Boutique from any and all liability for the unintentional exposure or harm due to COVID-19.

First Clients Name

First Name*

Middle Name

Last Name*

Phone*
First Clients Date of Birth*
First Clients Signature*
Second Clients Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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