COVID-19 Liability Waiver | Shanti's Studio

COVID-19 Information & Liability Waiver

Date

First and Last Name

Have you had a fever in the last 24 hours of 100°F or above?

YES

Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?

YES

Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?

YES

COVID-19 is a highly contagious virus that spreads from person to person. In addition to long-held and explicit sanitation measures Shanti's Studio of Esthetic has always adhered to, new preventative measures have been put in place to further reduce the spread of this novel coronavirus. However, these best practices still offer no guarantee regarding your potential risk of being infected.

Consent for Treatment

I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive skin care services from my esthetician.

Protection Of Personal Information

Shanti's Studio takes the security of your information very seriously. Your personal information will not be shared unless contacted by the state for contact tracing. You agree to the collection and use of information in accordance with this policy.

Reminder: A face covering/mask is required to be worn upon entering the studio.

Thank you for your cooperation!