Precautionary COVID-19 Liability Release Form

Due to the 2019-2020 outbreak of the novel Coronavirus COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following and sign below.

Symptoms of COVID-19 include:

● Fever

● Fatigue

● Dry cough

● Difficulty breathing

I, _________________________________________________ agree to the following:

❏ I knowingly and willingly consent to have a hair service during the COIVD-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 is a carrier given the current limits in virus testing.

❏ I understand and will follow the salons guidelines to prevent the spread of contagious viruses and help protect each other.

❏ I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.

❏ I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the last 30 days.

❏ I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.

❏ I affirm that I, as well as all household members, have not traveled outside the US, or to any city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days.

❏ I understand that REMI Salon and my Stylist 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 REMI Salon and my Stylist from any and all liability for the unintentional exposure or harm due to COVID-19. REMI Salon and all Independent Stylists within the facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.

Signature: ______________________________________         Date: _____________