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Covid 19 Waiver

This form must be completed prior to receiving any services at Mane Event Salon, Campbell CA.

I knowingly and willingly consent to have hair service(s) during the COVID-19 pandemic.

I Agree

I understand the COVID-19 virus has a long incubation period during with 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 Agree

I confirm that I am not presenting any of the following symptoms of COVID-19 and or any cold like symptoms: 

*Temperature above 99 degrees

*Dry cough

*Sore throat

*Loss of sense of taste or smell

*Shortness of breath

*runny or stuffy nose 

* body aches or severe head aches 

I Agree
 

I understand that due to the frequency of visits of other clients, the characteristics of the virus and the characteristics of hair services, that I have an elevated risk of contracting the virus simply by being in the salon

I Agree

I confirm that if I present symptoms between now and my appointment that I will cancel. I also understand that I can be denied service if I show up with symptoms

I Agree

I confirm that I have not been around anyone with these symptoms in the past 14 days

I Agree

I do not live with anyone who is sick or quarantined

I Agree

To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the salon’s strict guidelines. ( we encourage disposable double masking) 

I Agree

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

I verify that I have not traveled domestically within the United States by commercial airline, bus, or train within the past 5 days. 

I Agree

I agree that to the best of my knowledge this form is complete and true


 

 

First Client’s Name

First Name*

Last Name*

Phone*
First Client’s Date of Birth*
First Client’s Signature*
Second Client’s Name

First Name*

Last Name*
Second Client’s Date of Birth*
Third Client’s Name

First Name*

Last Name*
Third Client’s Date of Birth*
Fourth Client’s Name

First Name*

Last Name*
Fourth Client’s Date of Birth*
Fifth Client’s Name

First Name*

Last Name*
Fifth Client’s Date of Birth*
Sixth Client’s Name

First Name*

Last Name*
Sixth Client’s Date of Birth*
Seventh Client’s Name

First Name*

Last Name*
Seventh Client’s Date of Birth*
Eighth Client’s Name

First Name*

Last Name*
Eighth Client’s Date of Birth*
Ninth Client’s Name

First Name*

Last Name*
Ninth Client’s Date of Birth*
Tenth Client’s Name

First Name*

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

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
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*

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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