San Diego | California

Nails by Ann & Lounge Covid-19 Consent Form

By submitting the form below you agree to knowingly and willingly consenting to have nails/waxing/lash services during the COVID-19 pandemic.

We reserve the right to refuse service if this form is not submitted. Thank you!

First Name

Last Name

Phone

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.

YES

I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of the salon services, that I have an elevated risk of contracting the virus simply by being in the salon.

YES

I confirm that I am not presenting any of the following symptoms of COVID-19 listed below: • Temperature above 98.7 degrees • Shortness of breath • Loss of sense of taste or smell • Dry cough • Sore Throat

I am NOT PRESENTING SYMPTOMS

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

YES

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

I DO NOT

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.

YES

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 California Board of Cosmetology and Barbers recommend social distancing of at least 6 feet.

YES

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.

YES

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

YES

If I have children and they are recieving a service, I understand that they are my responsibility and will adhere to these verifications

YES

I DO NOT have children along

CONSENT TO SERVICE: by checking below, you agree to the following

I have been fully informed of the risks of service including but not limited to infection, scarring, difficulties in detecting melanoma, an allergic reaction from the service, and issues with any chemical. Having been informed of the potential risks associated with getting a service at this salon, I still wish to proceed with the service and I assume all risks that may arise from any service.

I hereby certify to the best of my ability and knowledge to inform of any changes in the above information that I have read and agree that the information I have provided is complete and true to the best of my knowledge.

During this COVID-19 pandemic, I understand I may get an infection at the salon. I hereby agree to not sue and to waive all liabilities towards my technician and the employer for anything that happens during or after my service is finished.

Please sign below. By signing and submitting, this serves as a Digital Signature and verifies that you fully agree to our safety policy for our services. This digital signature holds the same authority as a handwritten one. Thank you.

Digital Signature

Date of Appointment

Thanks for submitting!