@katrinaaissa

Covid 19 Health Declaration Form

To our Valued Clients,

In an effort to prevent the spread of COVID-19 and reduce the risk of exposure to you and our team, we are requesting that you complete this short declaration form.

Your participation is important to assist us in taking precautionary measures to protect you and others during your appointment and with that, you agree that you are getting services done at your own risk, releasing Katrinaaissa Beauty Artistry and its beauty artists from any liability relating to COVID-19.

Sincerely,

Katrina Aissa Sarabia, Esthetician

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

My body temperature is lower than 98.6°F/ 37.5°C , I am not experiencing the ff. symptoms: fever, shortness of breath, lost of sense, taste or smell, runny nose, dry cough, sore throat, chills, aches and pain

I verify that I have not traveled outside CANADA In the past 14 days to countries that have been affected by COVID-19 and I haven’t been in close contact with a Covid-19 patient in the last 14 days

I understand that if I am over the age of 55 years old, I am considered High Risk for COVID-19 virus. By checking this I understand and accept this statement.

I knowingly and willingly consent to having Hair and or Makeup service(s) during the COVID- 19 pandemic. By checking this I understand and accept this statement.

Initials

Date

Thanks for your support and cooperation!