Client Covid-19 forms

Covid-19 Health Declaration

First Name

Address

Last Name

City / Zip Code

Phone

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

I will comply with the covid-19 sanitation rules.

COVID-19 RISK LIABILITY WAIVER

We have no way of truly knowing who has been exposed to or is infected with COVID-19.

I am agreeing to assume all risks associated with entering a public establishment. I am choosing to be serviced at my own risk of being exposed to COVID-19.

The salon, hairstylist, or staff of HAIRCHALET is not liable for any possible exposure that I may have with any surface or individual(s) that may be contagious with COVID-19 or any other infection or disease. I will adhere to social distancing, hand washing procedures, and a face mask.

I agree to following health and safety procedures as suggested by STATE OF NEW JERSEY and local government officials.

I declare that the info I’ve provided is accurate & complete.

Your Signature

Date

Thanks for submitting!