CONSENT TO RECEIVE HAIR SERVICES AND RELEASE OF LIABILITY WAIVER 

In light of the COVID-19 pandemic, the Pennsylvania State Board of Cosmetologists and Barbers recommends reopening barber and cosmetology salons and shops following strict guidelines in order to protect the safety of clients and employees. DCB is implementing those steps provided by the PA Board of Cosmetologists and Barbers. We look forward to providing you the professional services you are accustomed to while taking your safety into consideration.

Please read and complete all the following statements to receive service:

I knowingly and willingly consent to receive services from Diversified Cuts Barbershop during the COVID-19 global pandemic. I furthermore agree to not hold my personal service provider, Diversified Cuts Barbershop itself, or it’s ownership company Diversified Cuts Barbershop LLC liable if I become ill at any point after receiving services.

I understand that the COVID-19 virus has 2-to-14-day incubation period during which carriers of the virus may not exhibit symptoms but remain contagious. I also understand that it is impossible to determine who has the virus without proper medical testing.

I understand that due to the high traffic client volume, the characteristics of the virus, the close physical nature of haircuts services and in spite of elevated disinfection protocols, I am vulnerable to an elevated risk of contracting the virus simply by being present in the barbershop.

I confirm that I am not presenting any of the following symptoms of COVID-19 including but not limited to a fever, shortness of breath, dry cough, runny nose, or sore throat.

I confirm that I have not been in physical contact with a known COVID-19 positive individual.

I confirm that I have not traveled internationally within the last 14 days.

I understand that in order to help prevent the spread of COVID-19 and to help protect both clients and employees, I will have to follow the barbershop’s guidelines and procedures set forth by the company under guidance of the State Board of Cosmetology and Barbering.

CUSTOMER SIGNATURE*:

DATE OF SIGNING*:

YOUR EMAIL ADDRESS:
(If you want a copy of the signed waiver for your records)