COVID-19 WAIVER – PERSONAL SERVICES
Client Name: _______________________________________ Phone: __________________________
Do you have any of the following symptoms?
Shortness of Breath
None of the Above
Have you been in contact with anyone who has a confirmed case of COVID-19 in the past 14 days? YES or NO
If you’re a healthcare provider and the answer is YES, was this exposure without proper personal protective equipment (PPE)? YES or NO or NA
Have you been out of the state of MD in the past 14 days? YES or NO
RELEASE OF LIABILITY WAIVER
State of Maryland
I hereby agree that Tanique and Blown Dry Bar has a proper sanitation and disinfection plan in place and is not responsible for any accidental transmission of COVID-19 that could occur by being in their business or within close proximity of each other. I also agree that if I become symptomatic within 14 days of my visit, I will notify the business immediately.
Signature: _________________________________________________ Date: ______________________