COVID-19 CONSENT FORM 
Signed before every service
I, ______________________________________________, knowingly and willingly consent to have hair /skin/lash/waxing /reiki services during the COVID-19 pandemic. 
_________ 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 understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of above services, that I have an elevated risk of contracting the virus simply by being in the salon. 
_________ I confirm that I am not presenting any of the following symptoms of COVOID-19 listed below: 
• Temperature above 100 degrees • Shortness of breath • Loss of sense of taste or smell • Dry cough • Sore Throat 
_________I confirm that I have not been around anyone with these symptoms in the past 14 days. 
_________I do not live with anyone who is sick or quarantined. 
_________ 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 understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. And I understand that the CDC, OSHA and CA State Board of Cosmetology and Barbers recommend social distancing of at least 6 feet. 
_________ 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 verify that I have not traveled domestically within the United States by commercial airline, bus, or train within the past 14 days. 
I understand that Retreat, and its stylists/practitioners, cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client. 
By signing below, I agree to each above statement and release Retreat, and its stylists/practitioners from any and all liability for the unintentional exposure or harm due to Covid-19 and other communicable conditions. 
Signature ____________________________________________________________ 
Date ___________


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