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TIMELESS MOMENTS DAY SPA
Precautionary COVID-19 Liability Form

Due to the pandemic of COVID-19, we are taking extra precautions with the intake of each new client and exhibiting health history of clients. We are also taking extra precautions with new and existing sanitization and disinfecting practise. 
PLEASE COMPLETE THE FOLLOWING AND SIGN
I _______________________________ agree to the following;
			(print name)
Common symptoms of COVID-19 may include (but not limited to):
- dry cough
- fever
- shortness of breath
- fatigue 
- loss of smell, taste
- headache
- body aches/pain

I understand the symptoms listed above and affirm that myself AND all members of my household do not currently have, nor experienced the symptoms listed within the last 14 days.

I affirm that I, as well as all member of my household have not been diagnosed with COVID-19 within the laser 14 days.

I affirm that I, as well as all members of my household haven't come into contact with anyone possible COVID-19 infection or COVID-19 infected in the past 14 days.

I affirm that I, as well all member of my household have NOT traveled outside of the country within the past 14 days. 

I understand that TIMELESS MOMENTS DAY SPA cannot be held liable for any exposure to the virus or any other contagions caused by misinformation on this form or the health history form provided by each client. Furthermore, I agree to not hold Timeless Moments Day Spa or their associates, if i do contract COVID-19 or any other contagion. As i  have decided to come to their establishment at my own free will. 

I understand to respect all new policies and regulations implemented by Timeless Moments Day Spa and agree to follow their procedures accordingly. I understand Timeless Moments Day Spa has the right to immediately cancel my appointment if there is any contraindications. 

Your technician as well as all employees of Timeless Moments Day Spa agree that they abide by these same standards and affirm the same. We also affirm that we have further improved and expanded our sanitization protocols, to continue to fight the spread of COVID-19 and any other contagions. 

DATE : _____________________________

SIGNATURE : ________________________________________________

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APPROVED BY : ______________________________________________________

SIGNATURE : _________________________________________________________