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COVID 19 SERVICE WAIVER FORM 

I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not given the current limits in virus testing.

I am aware that the CDC recommends social distancing of at least 6 feet and the wearing of a mask while in an establishment under the current pandemic guidelines and I understand that the 6 foot distance is not always possible when receiving a service from my provider.

I acknowledge that Define Hair is following the guidelines set by the state of Maryland and State Board of Cosmetology and is taking all precautions to prevent the spread of infections.

I confirm that I am not currently presenting any of the following symptoms of COVID-19 which may included: Fever, Shortness of Breath, Loss of Sense of Taste or Smell, Dry Cough, Runny Nose and Sore Throat and that I have not been in the company of or in close contact with any individuals with the same symptoms or who have been diagnosed with COVID-19.

I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus and the CDC recommends social distancing of at least 6 feet for a period of 14 days to anyone who has traveled.

I verify that I have not traveled outside the United States in the past 14 days to countries that have been affected by COVID-19.

I agree to inform Define Hair as a courtesy should I or someone I have been in contact with contracts COVID-19.

I knowingly and willingly consent to have a service performed at Define Hair and assume all risks and liabilities. In the event that I contract COVID 19, I do not hold Define Hair, its Agents, or Employees liable for any reason. 

Date: October 27, 2020

First Guest's Name

First Name*

Middle Name

Last Name*
First Guest's Date of Birth*
I certify that I am 18 years of age or older
First Guest's Signature*
Second Guest's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Guest's 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*
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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