Covid-19 Waiver

PLEASE CHECK ALL STATEMENTS BELOW TO VERIFY ELIGIBILITY FOR TREATMENT AND ENTRY:

First Name

Last Name

● I have not been in contact with anyone displaying symptoms of COVID-19 with in the last 14 days

●I have not been confirmed positive for COVID-19 or been in contact with someone that has tested positive for COVID-19 within the last 14 days.

● I am not experiencing shortness of breath, sore throat, difficulty breathing, or swallowing.

●I am not experiencing chills, headaches, nausea/vomiting, runny nose, or sinus congestions.

●I have not traveled outside of Canada within the past 14 days.

●I agree to wear a mask, social distance and follow all other COVID-19 Policies while at W style Beauty.

● I agree this form has been signed and filled out within the 24 hours of my appointment at W style Beauty.

Date MM/DD/YY

Signature

● I acknowledge that the above answers are true to the best of my knowledge. I understand all the potential risks related to my treatment and acknowledge that W style Beauty has put in place mandatory preventative measures aimed to reduce the spread of COVID-19. I release and indemnify W style Beauty from any claims, or liability related to COVID-19 while that may be sustained by me while participating in this treatment and visit. I would like to proceed with my desired treatment

Thank you ！