COVID-19 Pandemic Salon & Spa Service Consent Form

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

Your Initials: 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.

Your Initials: 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.

Your Initials: I confirm that I am not presenting any of the following symptoms of COVOID-19 listed below:

• Temperature above 98.7 degrees

• Shortness of breath

• Loss of sense of taste or smell

• Dry cough

• Sore Throat

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

Your Initials: I do not live with anyone who is sick or quarantined.

Your Initials: 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.

Your Initials: 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 Virginia Board of Cosmetology and Barbers recommend social distancing of at least 6 feet.

Your Initials: 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.

Your Initials: I verify that I have not traveled domestically within the United States by commercial airline, bus, or train within the past 14 days.

Your Initials: I understand the dramatically high costs of PPE for our staff to follow legal guidelines and the cost of other protective gear, provided complimentary for our guests to be safe, and the Governor's mandates to slow down and spread out all appointments, our salon will be implementing a COVID-19 surcharge to balance out the additional costs required to make you and our staff as safe as possible.

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