COVID-19 Consent & Liability Waiver

I understand that, because spa therapy work involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By submitting this form, I acknowledge the following:

I AFFIRM that within the past 14 days, I have been free from the following symptoms: fever, sore throat, shortness of breath or any respiratory or flu symptoms
I AFFIRM that within the past 14 days I have not been UNMASKED when in contact with someone who has symptoms of COVID-19
I AGREE to wear my own mask the entire time I am at Alani Massage Therapy & Natural Nail Spa
I AGREE to text my spa therapist when I arrive and wait in my car until asked to enter the building
I AGREE have my temperature taken and my hands sanitized by my spa therapist prior to my appointment

I give my consent to receive treatment at Alani Massage Therapy & Natural Nail Spa and release my contact information for contact tracing.

Name*

First

Last

Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Phone*

Email*

Who Is Your Provider?*

Today's Date

I acknowledge and agree to all the above statements.*

I AGREE