k.Niccole...the SALON&SPA Intake Form

Please note that a NEW form WILL have to be filled out before each visit...

I agree

Your Name

First Name Last Name

Phone Number

Area Code Phone Number

YOUR BEST EMAIL

[email protected]

Date of your appointment

Date

WHAT BEST DESCRIBES HOW YOU FEEL ABOUT YOUR UPCOMING APPOINTMENT?

I'm looking forward to the 'k.Niccole EXPERIENCE I'm excited but I want to spend as little time as possible in public

SALON SERVICE PRE-SCREENING

1. HAVE YOU BEEN IN CLOSE CONTACT WITH ANY PERSON DIAGNOSED (confirm by testing) WITH THE COVID-19 VIRUS IN THE LAST 14 DAYS?

CLOSE CONTACT IS DEFINED AS

Being within approximately 6 feet of a covid-19 case
Close contact can occur when caring for, living with, visiting or sharing a healthcare waiting area or a room with a Covid-19 case
Having direct contact with infectious secretions of the Covid-19 case (eg being coughed on)

YES NO

2. HAVE YOU BEEN AROUND ANYONE THAT HAS HAD A FEVER, COUGH , SORE THROAT, MUSCLE ACHES OR SHORTNESS OF BREATH IN THE LAST 14 DAYS ?

YES NO

3. ARE YOU EXPERIENCING SEVERE ACUTE LOWER RESPIRATORY ILLNESS(COUGH, SHORTNESS OF BREATH) AND FEVER?

YES NO

4. I UNDERSTAND THAT IN ORDER TO RECEIVE A SALON SERVICE THAT I MUST WEAR A FACE MASK OR FACE SHIELD.

I agree

In efforts to reducing and additional spreading, PLEASE ONLY BRING KEYS, PHONE AND WALLET

I agree

GUEST LIABILITY RELEASE

Release of liability and agreement not to sue, indemnification, hold harmless, limitation of warranty

We all know that these times are uncertain times. The risk of Covid-19 are not well understood and there is controversy among the experts on how the virus can spread and difficulty in scientifically determining whether anyone has the virus at any moment in time

In consideration for providing haircuts and color, by signing below you agree to accept all responsibility for the risk that you may contact COVID-19. While we are taking your safety and that of our staff very serious, by employing new safety and sanitation initiatives, we cannot guarantee that any of these measures will completely protect you from contracting COVID-19

I agree that if I take any steps to make a claim for damages against k.Niccole...the SALON&SPA, it's agents, employees or any other released parties arising out of my receipt of any services during my visit to k.Niccole...the SALON&SPA facilities, I shall be obligated to pay all attorney's fees and cost incurred as a result of such claim.

I acknowledge that I can go elsewhere to have my services done and I acknowledge that k.Niccole...the SALON&SPA is not the only hair service providers. By signing this agreement, I acknowledge that I am free to go to other salons who may not require my agreement to accept responsibility for contracting COVID-19 and I choose to have these services.

k.Niccole...the SALON&SPA RESERVES THE RIGHT TO TURN AWAY ANY GUEST THAT VISIBLY PRESENTS SYMPTOMS AS DESCRIBED ABOVE OR THAT HAS CHECKED YES TO ANY OF THE ABOVE QUESTIONS.

IN ADDITION, THE k.Niccole...the SALON&SPA team is screened daily at arrival utilizing the above protocols. Anyone in answering or exhibiting symptoms will not be allowed inside the building or at work until they test negative for COVID-19 or are symptom free.

Please sign attesting your information is accurate and true and that you accept responsibility fully for your salon visit to k.Niccole...the SALON&SPA *

Clear

k.Niccole...the SALON&SPA COVID-19 SERVICE WAIVER