EmailMe Form - Covid -19 Waiver Form

BY ARRIVING AT YOUR RESERVED APPOINTMENT, YOU HAVE AGREED TO THE POLICIES BELOW. YOU ARE VISITING TRUBEAUTY HAIR STUDIO & HAIR LOSS CENTER,LLC AT YOUR OWN WILL AND RELEASE STACY HAMMOND, OF ANY LIABILITY DUE TO ILLNESSES, INCLUDING COVID-19, CORONAVIRUS OR ANY STRAND IT MAY CARRY. THANK YOU! * *

I Agree

Name *

First Last

Email *

Phone *

### - ### - ####

I agree to bring and wear a mask. *

I Agree

I agree to wait outside until previous client has left and I am invited in. *

I Agree

I currently have at least 2 of these symptoms - Shortness of breath, Fever, Chills, Repeated shaking with chills, Muscle pain, Headache, Sore throat, Loss of taste or smell, Vomiting, Diarrhea. *

YES

NO

I have had a fever above 99 degrees within the last 2 days *

YES

NO

I have come into close contact (within 6 feet) with someone who has a laboratory confirmed COVID – 19 diagnosis in the past 14 days? *

YES

NO

I acknowledge that I AM NOT currently waiting for test results from a recent Covid 19 test. *

I am not waiting for Covid test results

Date *

MM / DD / YYYY