FREE Liability Release Form for Novel Covid 19 Waiver Form- Inkbox Artistry
( STUDIO OR DBA) Pre Cautionary Corona Virus Liability Release Form
Due to The 2019-2020 Global Pandemic Outbreak of the Novel CoronaVirus, Covid- 19, we are taking extra precautions with the intake of each client, health history review, as well as the sanitation and disinfecting practices. Please complete the following below:
Symptoms of Covid 19 includes:
- Fever
- Chills
- Fatigue
- Muscle pain
- Headache
- Sore throat
- Dry Cough
- New loss of taste or smell
______ I understand the above symptoms and affirm that I and any household members, do not currently have nor experienced the above symptoms within 14 days.
______ I affirm that I, as well as all household members, have not traveled internationally within the last 14 Days.
______ I affirm that I, as well as all household members, have not traveled to a highly impacted area or “hot spots “ in the last 14 Days.
______ I affirm that I, as well as all household members , have not been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
______ I affirm that I, as well as all household members , have not been diagnosed with Coronavirus/Covid-19 within the last 30 Days.
______ I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
______ I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that ( STUDIO OR DBA) has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
______ I further acknowledge that ( STUDIO OR DBA) and my Permanent Makeup Artist Provider can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, the studios staff of ( STUDIO OR DBA) , and other clients and their families.
______ I voluntarily seek services provided by ( STUDIO OR DBA) and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19.
______ I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
_______By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk I may be exposed to or infected by COVID-19 that such exposure or infection may result in personal injury, illness, permanent disability, and death.
_______ I understand that the risk of becoming exposed to or infected by COVID-19 during my service by any employee or staff member in our studio may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families.
______ I hereby release and agree to hold ( STUDIO OR DBA) and my Permanent Makeup Artist Provider, harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from ( STUDIO OR DBA) and my Permanent Makeup Artist Provider.
_______I understand that this release discharges ( STUDIO OR DBA) and my Permanent Makeup Artist Provider from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from ( STUDIO OR DBA) and my Permanent Makeup Artist Provider This liability waiver and release extends to the salon together with all owners, partners, and employees.
I agree that all statements above has been answered to the best of my ability and knowledge.
_________________Print Name _________________ Signature _____________ Time & Date of Arrival
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