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Beauty Salon Consent Form -Form Fill

Section One
Q1

Client Name

First Name
Q2

Client Name

Last Name
Q3

Appointment Date & Time

Date
Q4

Appointment Date & Time

Hour Minutes
Q5

Appointment Date & Time

AM/PM Option
Q6

By checking the boxes, you confirm that you agree with the following statements:
Q7

Do you have any of these symptoms? - cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste/smell
Q8

Within 14 days, have you been in contact with anyone that has COVID-19 symptoms or get infected?
Q9

Are you living with anyone that is get infected or quarantined due to COVID-19?
Q10

Parent/Guardian Name (if applicable)

First Name
Q11

Parent/Guardian Name (if applicable)

Last Name
Q12

Date

Date
Q13

Client/Parent/Guardian Signature