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COVID-19 Disclaimer

Name *

First

Last

Email *

Address *

1. Are you experiencing a cough? *

No
Yes

2. Are you experiencing a shortness of breath? *

No
Yes

3. Have you had a fever (above 36.6C degrees) in the last 14 days? *

No
Yes

4. Have you noticed a loss or change in your sense of taste or smell? *

No
Yes

5. Have you had any contact with anyone that has suspected COVID-19 in the last 14 days? *

No
Yes

I have understood, read and completed this form truthfully to my knowledge.

I knowingly and willingly consent to having services at Gina Collins Cosmetic Academy during the COVID-19 pandemic.

I consent for the services to be carried out which involves a staff member of the Gina Collins Cosmetic Academy team being in physical contact with me with less than 2 metres distance.

I confirm to my knowledge that I, my household or social bubble have not been in contact with anyone that has had symptoms of COVID-19 in the last 14 days.

To prevent the spread of the virus and protect each other, I confirm that I will strictly follow Gina Collins Cosmetic Academy guidelines.

If guidelines are not strictly followed, I understand that Gina Collins Cosmetic Academy has the right to cancel the appointment with the full cost of the service being charged and any other paid costs being non-refundable.

Liability *

I confirm that I release the Gina Collins Cosmetic Academy staff member performing the service and Gina Collins Cosmetic Academy as a business from any and all liability for the unintentional exposure or harm due to COVID-19.

Name

35425

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