Covid19/Vaccine Waiver Consent
Form must be read & consented to before visiting or booking
COVID -19 VACCINE RECEPIENTS.
YOUR WILL BE CANCLED APPOITMENT IF YOU ARE HAVING ANY SYMPTONS OF THE SHOT.
THANK YOU FOR YOUR UNDERSTANDING.
We appreciate you.
THIS IS NOT THE COVID FORM JUST THE MASSAGE INTAKE FORM.
COVID INTAKE WAIVER FORM
Please take a moment to read, agree and submit this form. By submitting the form below you agree to knowingly and willingly consenting to having skin/body service during the COVID-19 pandemic and you adhere to our procedures of accepting appointments.
I hold the best interest of EBM and Staff and I do not wish to put anyone in harm by falsely agreeing to the questions below
- I Agree
I understand that EBM reserves the right to refuse service if this form is not submitted or if I have not agreed to all the questions.
- I AGREE
I agree to getting my temperature checked when entering EBM studio and I agree to wearing a mask inside the studio and possible wearing the mask face up during the massage . I also agree to pay $2 for a mask if I do not have one.
- I AGREE
- I AGREE
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of massage and facial services, that I have an elevated risk of contracting the virus simply by being at EBM.
- I AGREE
To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the salon’s strict guidelines and cancel my appointment if I do not agree.
- I AGREE
I AM NOT currently experiencing any of the known COVID19 symptoms: abnormal fatigue, diarrhea , loss of smell/taste, dry cough, difficulty breathing or a sore throat? If so please call immediately cancel or reschedule
- I AGREE
My household members have not been in close contact (within 6ft.) of someone who has had a confirmed case of COVID19 in the past 14 days? IF so please reschedule for 14 days out. *
- I AGREE
I confirm that I AM NOT presenting any of the following symptoms of COVOID-19 listed below: * • Temperature above 98.7 degrees • Shortness of breath • Loss of sense of taste or smell • Dry cough • Sore Throat *
I confirm that I HAVE NOT BEEN around anyone with these symptoms in the past 14 days. *
- I AGREE
I Agree I DO NOT LIVE with anyone who is sick or quarantined. If so please call immediately cancel or reschedule for 14 days out.
- I AGREE
I agree that I HAVE NOT traveled outside the United States in the past 14 days. If so please call immediately cancel or reschedule for 14 days out.
- I AGREE
I agree if am a health care worker, first responder or work in an hospital, I should contact us Immediately before coming in to EBM studio.
-I AGREE
By typing your name and submitting, this serves as a Digital Signature and verifies that you fully agree to our consent/waiver and safety policy for our services. This digital signature holds the same authority as a handwritten one. Thank you.
COVID WAIVER IN EFFECT
Wednesday, July 8th 2020 at 12am to Thursday, Dec. 31st 2020 at 12am
2001 Ridge Road
Rockwall, TX
RSVPs are enabled for this event.