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Emerald Day Spa Waiver and Consent

In consideration of my participation in spa services (manicures, pedicures, waxing, facials, massage, tinting, hot stone massage and al other spa services) with Emerald Day Spa LTD, I hereby release, discharge and covenant not to sue Emerald day Spa LTD  located at 2807 Cedar Hill Rd, its directors, officers, employees and agents from liability from any and all claims including negligence of Emerald Day Spa, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the salon service. 

I understand that the esthetician does not diagnose illness, disease or other physical or mental disorders, or prescribe pharmaceuticals and that services rendered by the esthetician are not medical in nature and are not a substitute for diagnosis and treatment by a licensed medical professional. 

I have stated all known medical conditions, and have consulted a physician regarding checked or prescribed conditions, and I shall update my esthetician with any changes in my health, and my esthetician shall not be liable should I fail to do so. 

I hereby understand that my participation in the spa service shall carry certain inherent risks that cannot be eliminated regardless of care taken to avoid injuries. Risks may include, but are not limited to, minor injuries such as bruises, scratches, skin irritation and minor bleeding, major injuries such as eye injury, loss of sight, infection, heart attacks, and concussions, and catastrophic injuries such as paralysis or death. 

I hereby state that my participation in this spa service is voluntary, and I assume all such risks. I shall indemnify and hold harmless Emerald Day Spa Ltd, their respective directors, officers, employees, agents, representatives, insurers, successors and assigns, from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including legal fees brought as a result of my participation in salon service(s), and shall reimburse them for any such expenses as incurred. 

If any part of this waiver shall be held invalid, the balance shall, notwithstanding, continue in full legal force and effect. 

I have hereby read and understand this waiver and release Emerald Day Spa Ltd, its directors, officers, staff, contractors, estheticians and practitioners from any and all liability, past, present and future relating to salon services. I am giving up substantial rights, including rights to sue, and I acknowledge that I am signing this waiver voluntarily. 

I also understand that the novel coronavirus that can cause COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that the COVID-19 virus is extremely contagious and is believed to spread by person-to-person contact; as a result, our regulatory bodies and our provincial health officer recommend social distancing.

I recognize that Emerald Day Spa and its staff are closely monitoring this situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with this elective treatment. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective treatment, and I give my express permission for Emerald Day and its staff to proceed with the same.

I understand that even if I have been tested for COVID and received a negative test result, the tests in some cases may fail to detect the virus or I may have contracted COVID after the test. I understand that, if I have a COVID-19 infection, and even if I do not have any symptoms for the same, proceeding with this elective treatment/procedure/surgery may lead to a higher chance of complication.

I understand that possible exposure to COVID-19 before/during/after my treatment/procedure/surgery may result in the following: a positive COVID-19 diagnosis, extended quarantine/self-isolation, additional tests, hospitalization that may require medical therapy, Intensive Care treatment, and possible need for intubation/ventilator support, short-term or long-term intubation, other potential complications, and the risk of death. In addition, after my elective treatment/procedure/surgery, I may need additional care that may require me to go to an emergency room or a hospital.

I understand that COVID-19 may cause additional risks, some or many of which may not currently be known at this time, in addition to the risks described herein, as well as those risks for the treatment itself.

I have been given the option to defer my treatment to a later date. However, I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired treatment.

I UNDERSTAND THE EXPLANATION AND HAVE NO MORE QUESTIONS AND CONSENT TO THE PROCEDURE.                                                                                                                                            

First Guests Name

First Name*

Last Name*

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

First Name*

Last Name*

Phone*
Second Guests Date of Birth*
Third Guests Name

First Name*

Last Name*

Phone*
Third Guests Date of Birth*
Fourth Guests Name

First Name*

Last Name*

Phone*
Fourth Guests Date of Birth*
Fifth Guests Name

First Name*

Last Name*

Phone*
Fifth Guests Date of Birth*
Sixth Guests Name

First Name*

Last Name*

Phone*
Sixth Guests Date of Birth*
Seventh Guests Name

First Name*

Last Name*

Phone*
Seventh Guests Date of Birth*
Eighth Guests Name

First Name*

Last Name*

Phone*
Eighth Guests Date of Birth*
Ninth Guests Name

First Name*

Last Name*

Phone*
Ninth Guests Date of Birth*
Tenth Guests Name

First Name*

Last Name*

Phone*
Tenth Guests 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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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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