Please Fill out no sooner than 48 hours before your Appt. Please Read thoroughly as some items have changed!

Amy Spencer Hair Salon, LLC

441 W 12300 S Suite 122

Draper, UT 84020

We have put together preventable measures to reduce the spread of COVID-19, however Amy Spencer Hair Salon, LLC cannot guarantee that you will not become infected with COVID-19. Amy Spencer Hair Salon, LLC commits to a healthy business operation by providing a sanitary environment, increasing physical space when available, requiring sick employees to stay at home, and other supportive practices.

I voluntarily agree to assume all the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability or death), illness, damage, loss, claim, liability, or expense of any kind that I may experience or incur in connection with my attendance. I hereby release, covenant not to sue, discharge, and hold harmless Amy Spencer Hair, LLC and its stylists, whether a COVID-19 infection occurs before, during, or after visiting Amy Spencer Hair Salon.

I have carefully read this agreement and fully understand its contents. I am aware this is a release of liability and sign it of my own free will

Amy Spencer Hair Salon agrees that they abide by the same standards and affirm the same. We also affirm that we improved and expanded our sanitation protocol to more thoroughly fight the spread of COVID-19 and other communicable conditions.

Common Symptoms of COVID-19 Include, but aren't limited to:

Nausea, Diarreah
Dry
Cough
Fatigue
Fever
Shortness of Breath
Sore Throat
Body Aches
Headache Loss of sense of smell

I AM NOT CURRENTLY ADVISED TO BE ISOLATED, OR QUARANTINED *
I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the last 18 Days *
I understand the above symptoms and I affirm that I, as well as all household members do not currently have, nor have experienced the symptoms listed above within the last 14 days *
For the Safety of myself, and the guests in my salon. I ask If you have been Diagnosed with COVID, I require you to wait 3-4 days longer than the health department. Please notify me if we need to move your appt. *
I affirm that, I as well as household members have not traveled outside the country, or to any city outside of our own that has been considered a "hot spot" for COVID-19 Infections within the last 18 days. *
I Understand that this business and my hairstylist cannot be held responsible for any exposure to the virus or any other contagion cause by misinformation on this form or the health history provided by each client. Furthermore I agree to not hold Amy Spencer Hair, LLC if I do contract COVID-19 or any other contagion as I have decided to come here on my own free will. *
By signing this agreement, I acknowledge the contagious nature of COVID-19, and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by being present inside Amy Spencer Hair Salon, and such exposure or infection may result in personal injury, illness, permanent disability or death. I affirm that I have not suffered any flu-like symptoms in the past 14 days nor have I knowingly come in contact with anyone diagnosed with COVID-19 in the past 18 days. Signature (parent if client is under 18) If anything changes with your health after signing this form, but before your appointment please notify Amy and she will reschedule you. THIS FORM IS FOR MY RECORDS ONLY. Your info will not be shared, and it's secure. If you cannot answer all of these questions please text me. *
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