HONEY BUNZ CoVid QUESTIONAIRE AND RELEASE

 

 

HONEY BUNZ CoVid QUESTIONAIRE AND RELEASE

The safety of our employees, clients and visitors remain our overriding priority. As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve and spread globally, Honey Bunz is monitoring the situation closely and will periodically update company guidance based on current recommendations from the Centers for Disease Control and Prevention and the World Health Organization. To prevent the spread of COVID-19 and reduce the potential risk of exposure, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in this building.

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Honey Bunz Organic Day Spa has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I further acknowledge that Honey Bunz Organic Day Spa can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that 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, spa staff, and other spa clients and their families.
I voluntarily seek services provided by Honey Bunz Organic Day Spa and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.

I attest that:
* 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 new 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 of America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and 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 Coronavirus/COVID-19.

I hereby release and agree to hold Idalynn Cosmetics, LLC dba Honey Bunz Organic Day Spa 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 spa, or that may otherwise arise in any way in connection with any services received from Honey Bunz Organic Day Spa. I understand that this release discharges Honey Bunz Organic Day Spa from any liability or claim that I, my heirs, or any personal representatives may have against the spa 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 Honey Bunz Organic Day Spa. This liability waiver and release extends to the spa together with all owners and employees.

Name: _______________________ Signature: _____________________. Date:___________________

Please write your signature in the box below