Covid-19 Assessment & Acknowledgement Form

Have you experienced any of the following symptoms?

I Understand the above symptoms and affirm that I, as well as my household members DO NOT currently have, nor have experienced the symptoms listed above within the last 21 days.

YesNo

I affirm that, I as well as household members, have NOT been diagnosed with COVID-19 within the last 30 days.

YesNo

I affirm that I, as well as all household members, have NOT traveled outside of the country, or to any city outside of our own that has been considered a "hot spot" for COVID-19 infections within the last 30 days.

YesNo

I understand that Erin Antos Hair Design screens all clients for possible COVID-19 symptoms per the most current guidelines. However, carriers of this virus may be completely asymptomatic as the COVID-19 virus has a long incubation period during which carriers of the virus may show no symptoms and still be contagious. While we adhere to strict CDC, Federal and Provincial Health Authority Standards as they currently exist.

YesNo

I understand that the business and owner of Erin Antos Hair Design cannot be held liable for any exposure or potential exposure to the virus or any other contagion.

YesNo

I have read the Covid-19 Safety Procedures of Erin Antos Hair Design and agree to abide by these terms and conditions.

YesNo