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HEALTH CONSENT WAIVER

Please read the following  health consent form below, fill in and sign it to agree to the terms of the waiver.

Biro Dominican Salon is doing everything we can to protect you, our client, our community, and our staff. To this extent, we will be following the Center of Disease Control (CDC) and local health department guidelines with regard to social distancing practices and sanitation in order to reduce the spread of Novel Coronavirus, or COVID-19. This will require our staff to maintain six (6) feet of distance between ourselves and you, the client, as much as possible in our salon setting. We will also be requiring this same procedure for client-to-client contact in order to limit the exposure to all individuals. Only the person receiving the service will be allowed in the salon.

 All chair and  stations will be sanitized and/or disinfected between each client. New capes will be given to each client. Hard surfaces are disinfected every two hours. Staff will follow proper hand washing protocols between each client. We will temporarily suspend all complimentary services.

 Biro Dominican Salon requires all individuals to utilize approved masks by CDC, to reduce the risk of exposure to yourself and others. It is also required of everyone to wash or sanitize their hands upon arrival of your appointment, after using the restroom, sneezing, or coughing.

 If we all work together, we can overcome the spread of this virus as well as other infectious diseases. We welcome you to Biro Dominican Salon!

 By filling out this  form you agree to comply with the written instructions above and agree that you are at the salon at your own risk,  you confirm that you do not have any COVID-19 symptoms or combinations of symptoms, that may appear 2-14 days after exposure include:

Fever or chills

Cough

Shortness of breath or difficulty breathing

Fatigue

Muscle or body aches

Headache

New loss of taste or smell

Sore throat

Congestion or runny nose

Nausea or vomiting

Diarrhea

This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19.

You release Biro Dominican Salon from any liability relating to COVID-19.

First Guest Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Guest Date of Birth*
Guest Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:
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*

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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