NATALIE FEARNLEY

Name *

First Name

Last Name

*

I understand that the novel coronavirus causes the disease known as COVID-19. I understand the novel coronavirus has a long incubation period during which the carriers of the virus may not show not show the symptoms and may still be contagious. I understand that: 1. physical distancing of 2 metres may not be possible at all points whilst at the appointment receiving services. 2. I must sanitise my hands before entering 3. I must make all attempts to cover my mouth and nose in the event of coughing and/or sneezing and then immediately sterilise my hands 4. I will minimise the touching of common surface/areas 5. I may be unable to proceed with services if they are deemed unsafe to myself or a staff member 6. I will NOT bring children or anyone else who does not have an appointment into the salon. 7. I understand the staff will do everything possible to minimise the spread of COVID-19, but will not hold them responsible should I contract COVID-19.

Yes I understand

*

I confirm that: 1. I am not currently positive for COVID-19 2. I am not waiting for the results of a laboratory test for COVID-19 3. I have not been identified as a contact of someone who has tested positive for COVID-19 or been asked to self-isolate by any government agency. 4. I am not in high risk category for increased illness or death from COVID-19, including : diabetes, cardiovascular disease, hypertension, lung disease including moderate to severe asthma, being immunocompromised (including transplant recipient), having active malignancy or over the age of 65. 5. I am NOT presenting with any of the following symptoms of COVID-19: - Fever > 38C, or 100F, chills or body aches - Cough - Sore Throat - Shortness of breath / Difficulty breathing - Flu-like symptoms - Runny Nose - Loss of smell or taste

I confirm to not having any of the above

*

I will immediately notify the salon if I contract the virus within two weeks following my visit.

Yes

*

By agreeing to the below, I verify that the information I have provided on this form is truthful and accurate.

I agree