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Permanent Makeup COVID-19 LIABILITY RELEASE WAIVER THIS FORM MUST BE COMPLETED AND SIGNED BEFORE TREATMENT The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations,guidelines,and some prohibitions which adheres to comply. Symptoms of COVID-19 include: • Fever • Fatigue • Dry Cough • Difficulty Breathing I agree to the following: ❑ I, nor members of my household, have not experienced any of the symptoms listed above within the last 14 days. ❑ I,nor members of my household,have not travelled internationally in the last 30 days. ❑ I, nor members of my household, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus(COVID-19). ❑ I,nor members of my household,have not been diagnosed with the Coronavirus(COVID-19)within the last 30 days. ❑ The venue cannot be held liable from any exposure to the Coronavirus (COVID-19) caused by misinformation on this form or the health history provided by each client. ❑ I understand that due to the frequency of visits of other clients,the characteristics of the virus,and the characteristics of these services that I have an elevated risk of contracting the virus simply by being in the establishment. To prevent the spread of the contagious virus and to help protect each other,I understand that I must follow the establishment's guidelines: • Reschedule appointment if you are feeling unwell; • No additional guest is allowed; • Wearing a mask is required upon arrival and during the entire procedure; • Wash hands upon arrival; • Limit conversation during the procedure. By signing below, I agree to each above statement and release the venue and its employees from any and all liability for the unintentional exposure or harm due to Covid-19 and other communicable conditions. Date: Client Name (Printed) Client Signature