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This waiver is a Self Attestation Waiver. You are verifying and truthfully attesting that you ARE or ARE NOT Fully Vaccinated.  This information stays with the business. We pride ourselves on providing a very safe environment for all people including the stylists at Mane Event Salon and will continue to do so.  We will not turn anyone away but we will have strict guidelines within the business to continue to keep all safe..  

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(UPDATED 06/21/2021).

I Agree

All guests will be required to wear a mask if they are not or decline to answer.  As the stylist do as well.

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 AND OR LIVE WITH ANYONE WHO IS SICK AND 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. 

I Agree

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

  July 25, 2021

 

First Guest Name

First Name*

Last Name*

Phone*
First Guest Date of Birth*
First Guest Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
First Guest Signature*
Second Guest Name

First Name*

Last Name*
Second Guest Date of Birth*
Second Guest Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
Third Guest Name

First Name*

Last Name*
Third Guest Date of Birth*
Third Guest Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
Fourth Guest Name

First Name*

Last Name*
Fourth Guest Date of Birth*
Fourth Guest Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
Fifth Guest Name

First Name*

Last Name*
Fifth Guest Date of Birth*
Fifth Guest Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
Sixth Guest Name

First Name*

Last Name*
Sixth Guest Date of Birth*
Sixth Guest Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
Seventh Guest Name

First Name*

Last Name*
Seventh Guest Date of Birth*
Seventh Guest Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
Eighth Guest Name

First Name*

Last Name*
Eighth Guest Date of Birth*
Eighth Guest Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
Ninth Guest Name

First Name*

Last Name*
Ninth Guest Date of Birth*
Ninth Guest Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
Tenth Guest Name

First Name*

Last Name*
Tenth Guest Date of Birth*
Tenth Guest Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Attestation
SELF ATTESTATION*
I DECLINE to divulge information on my vaccination/ and or AM NOT fully vaccinated. ( I acknowledge this will require me and or others with me to wear a mask with-in the Mane Event Salon setting.
I self attest that I AM FULLY VACCINATED with one of the following vaccinations. (Pfizer,Maderna,J&J Johnson and Johnson or any other approved Vaccine
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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