DASS | Consent Forms

Allergy consent form

Although it is impossible to list every potential risk and complication, I have, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand the service and accept the risks. I understand that Design Affair Salon Studio (DASS) cannot be held liable for any exposure to any allergens caused by misinformation on this form or the health history provided. I understand that there is a risk of becoming exposed to and/or allergic to any allergens.

Fever or Feeling Feverish

Yes

A New Cough

Yes

A New Sore Throat

Yes

New Headache

Yes

Chills

Yes

Shortness of Breath

Yes

New Muscle Aches

Yes

New Loss of Smell or Taste

Yes

Running Nose

Yes

I understand the above symptoms and confirm that I, along with all household members, do not currently have, or experienced the symptoms listed above WITHIN THE LAST 14 DAYS. I and all household members have not been diagnosed and or exposed with COVID-19 WITHING THE LAST 30 DAYS. I voluntarily seek services provided by Design Affair Salon Studio (DASS) and acknowledge that I am increasing my risk to the exposure of the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures and must wear a facemask prior to receiving services to reduce the spread of the virus. I acknowledge that Design Affair Salon Studio (DASS) cannot guarantee that I will not become infected with the Coronavirus/COVID-19. I understand the risk of becoming exposed to and/ or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Design Affair Salon Studio (DASS) staff and their families. and that the CDC and many other public health authorities still recommend practicing social distancing. I understand that this release discharges Design Affair Salon Studio (DASS) from any liability or claim that I, my heirs, or any personal representatives may have against Design Affair Salon Studio (DASS) with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Design Affair Salon Studio (DASS) with all owners, partners, and employees. CANCELATION/REFUND: If I come in contact with anyone who has been diagnosed with COVID-19 WITHIN 30 DAYS and /OR are showing any symptoms above WITHIN 30 DAYS, please notify DASS as soon as possible. I may cancel my service(s) at any time. If in the case a cancellation happens due to COVID-19 exposure, I will forfeit my full retainer payment/ deposit.

I acknowledge that I was notified of the DASS Glam Team’s potential Covid-19 exposure. I understand that even though the DASS Glam Team has tested and provided a negative test result, it could potentially be a false negative result. I acknowledge that Design Affair Salon Studio (DASS) cannot guarantee that I will not become infected with the Coronavirus/COVID-19. I understand that this release discharges Design Affair Salon Studio (DASS) from any liability or claim that I, my heirs, or any personal representatives may have against Design Affair Salon Studio (DASS) with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Design Affair Salon Studio (DASS).

By signing this document, I understand and acknowledge that I have read the content and answered the questions to the best of my knowledge. I also understand and will comply to prevent the spread of COVID-19.

Allergy & Covid-19
Consent Forms

COVID-19 Health-Screening Waiver

are you experiencing these symptoms:

Allergy consent form

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Allergy & Covid-19 Consent Forms

COVID-19 Health-Screening Waiver

are you experiencing these symptoms:

Allergy consent form

Thanks for submitting!

Be the first to know about our sales and promotions.

Allergy & Covid-19
Consent Forms