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By reading this document and completing and signing the form below, you agree to comply with the instructions of Lumie Salon and acknowledge that you are visiting the salon at your own risk, releasing Lumie Salon, its principals, employees, and staff, from any liability relating to Novel Coronavirus/COVID-19.

I acknowledge the contagious nature of the Novel Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.

I further acknowledge that Lumie Salon has put in place preventative measures to reduce the spread of the Novel Coronavirus/COVID-19.
I further acknowledge that Lumie Salon cannot guarantee that I will not become infected with the Novel Coronavirus/COVID-19. I understand that the risk of becoming exposed to and/or infected by the Novel Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families.

I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
 I further attest:

  • I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or loss of taste or smell.

  • I have not traveled internationally within the last 14 days.

  • I have not traveled to a highly impacted area within the United States or elsewhere in the last 14 days.

  • I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Novel Coronavirus/COVID-19.

  • I have not been diagnosed with Novel Coronavirus/COVID-19and not yet cleared as non-contagious by state or local public health authorities.

  • I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Novel Coronavirus/COVID-19.

I hereby release and agree to hold Lumie Salon, its principals, employees, and staff harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Lumie Salon. I understand that this release discharges Lumie Salon, its principals, employees, and staff from any liability or claim that I, my heirs, or any personal representatives may have against the salon 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 Lumie Salon.

Thanks for submitting!

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