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Styling from head to toe!

 954-767-1006
1501 SE 17th Street Causeway
Fort Lauderdale, Florida 33316
Mon-Sat 10:00 am - 8:00 pm
Sun 11:00 am - 6:00 pm

SERVICE AGREEMENT COVID-19

 

This service agreement consent form applies to any of the services performed at Harbor Nails & Hair facilities including Nails, Manicure, Pedicure, Wax, Facial, Hair Services.

Please read the form below and check yes or no to indicate that you understand the implications of signing.

MEDICAL CONDITION

Please review email address.

Please enter your full name.

Please enter your phone number

Do you currently have, or have you had any of the following conditions within the past 14 days?
Cough, fever, shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell.

Please choose Yes or No.

Do you have knowledge, or have you had close contact in the past 14 days with a person who has been diagnosed with COVID 19?

Please choose Yes or No.

Have you been in an area with known risk of/reported cases of COVID 19, or traveled by public transportation (bus, train, plane, etc.) within the last 14 days?

Please choose Yes or No.

CONSENT TO SERVICE

By submitting this form, you agree to the following:

I have been fully informed of the risks of service including but not limited to, infection, scarring, melanomas, allergic reaction to service, latex gloves, and antibiotics. Having been informed of the potential risks associated with getting a service at Harbor Nails & Hair and contracting the virus by merely being in the salon.

I still wish to proceed with service application and I assume all risk that may arise. I will inform the technician of any discomfort that I may experience at any time during my services to allow them to adjust accordingly.

I hereby certify to the best of my ability and knowledge to inform of any changes in the above information, and that I have read and agree that the information I have provided is complete and true to the best of my knowledge.

During this COVID-19 pandemic, I understand I may get an infection at the salon. I hereby agree to not sue and to waive all liabilities towards my technician and the employer for anything that happens during or after my service is finished.

Please enter your full name.

Invalid Input

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