CHECKIN | Icon Salon Spa

Risk Acknowledgment Form

COMPLETE FORM AT TIME

OF YOUR APPOINTMENT

First Name

Last Name

Phone

My appointment today is with:

For the safety of our clients and co-workers please agree to the statements listed below.

Most common symptoms of COVID 19 include:

Fever
Fatigue
Dry Cough
Difficulty Breathing

No one in my household, including myself has been exposed to anyone who has been diagnosed with Covid-19 in the past 14 days.

I have not had any of the symptoms listed above in the past 14 days.

No one in my household, including myself, has been diagnosed with COVID-19 in the past 30 days.

No one in my household, including myself, has been out of the country or to any other city or area besides our own that is considerd a "hot spot" for COVID 19 in the past 30 days.

I understand that Icon Salon Spa and our salon/spa professionals have implemented recommended disinfection protocols but the risk of infection of Covid 19 still exists and by attending my appointment I acknowledge that risk.

If you are unable to agree to all the statements above, please contact your salon/spa professional to reschedule your appointment.

ICON SALON SPA and your salon/spa professional agree that they abide by these same standards and affirm the same. We also affirm that we have expanded our sanitation protocols to more thoroughly fight the spread of COVID 19.