Client Visit Waiver | Artrageous Ink

CV-19 Safe Client Visit Waiver

By completing and submitting this form, you are knowingly and willingly consenting to having tattoo services performed during the COVID-19 Pandemic and you agree to adhere to all safety and sanitation protocols now required by the shops service provider.

Your Name (required)

Your Email (required)

Phone Number (required)

My Baseline pre-visit temperature must be below 99 degree Fahrenheit to receive a service. Today my temperature is : * (required)

I am aware that due to limited testing for the COVID-19, the virus has a long incubation period during which time carriers of the virus may be asymptomatic (no symptoms) and still be highly contagious. I also acknowledge that it is impossible to determine who has it . * (required)
Yes, I am aware.

I also acknowledge that I understand that anytime I am within close proximity (less than 6ft) of my service provider or any other person, I could have an elevated risk of contracting the virus should it be present. * (required)
Yes

I confirm that none of the following COVID-19 symptoms have been present within the last 2-14 days: Fever, Shortness of Breadth, Loss of taste or smell, Dry Cough, Runny Nose, Sore Throat, Chills, Repeated Shaking with Chills, Muscle Pain or Head Ache * (required)
none of above

I affirm that I have not been exposed to anyone that has been diagnosed with COVID-19 within the past 14 days inside or outside of the country I reside in. * (required)
I affirm

I affirm that I have not traveled domestically (outside of my state) or internationally (outside of my country) within the past 14 days. * (required)
I affirm

Do you suffer from allergies * (required)
yesno
If yes, please explain

I agree by providing my name below, I am in essence rendering my signature in acknowledgement of the completed statements on this form and that all information is accurate as of the date of this form. * (required)