Please Fill Out the Required Information On The Day of Your Appointment

(This form is for our info only and does NOT book your appointment)

My Little Wax Bar
RETURN CLIENT 
COVID-19 Waiver and Release
Personal and Confidential
MLWB assures you that providing a safe and healthy environment for our clients and staff is our top priority.

 

We take great pride in keeping our salon clean and safe, and we know this is more important than ever to continue in keeping everyone healthy. We are taking guidance from our governing agencies which recommends regular cleaning as one of the most important, preventive measures we can take. In addition to frequent hand washing and frequent sanitizing, we’ve enhanced our daily cleaning routines with more rigorous procedures and additional focus on high-touch and traffic areas.  All rooms (chairs, countertops, trays, doorknobs, etc) are sanitized with EPA approved sanitizers between clients.

COVID-19 Customer Waiver
I consent to inform My Little Wax Bar that I have not been exposed to COVID-19 or have had symptoms of COVID-19 within the last 14 days of my appointment. 
 
I consent that I do not have any of the following at the time of my appointment:

  • Have you been around anyone exhibiting these symptoms within the past 14 days?

  • Cough, Sore Throat, Fever, Congestion or Runny Nose

  • Shortness of Breath or Difficulty Breathing, Nausea and/or Vomiting, Diarrhea

  • Fatigue and/or Body Aches, Muscle Soreness

  • Loss of Smell and/or Taste​

  • Are you living with anyone who is sick or quarantined? 

  • If any of these apply to you, you will be asked to reschedule your appointment for no earlier than 14-days

By submitting this form I agree that the above declaration is true and correct and that any dishonest answers may have Serious Health Implications.
During this COVID-19 pandemic, I understand that by visiting any public place that I may be exposed to COVID-19.  I agree that I am opting to receive services at My Little Wax Bar of my own choice and that I will not hold My Little Wax Bar or any of it's employees liable, should I contract COVID-19.

I give permission to my esthetician/My Little Wax Bar to perform waxing/skin care services as discussed and will hold her and her staff harmless from any liability that may result from this treatment/service.

 

I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.

 

I have read and understand the post-treatment home care instructions/suggestions posted on this establishments website.

 

I am willing to follow recommendations made by my esthetician for a home care regimen that can/may minimize or eliminate possible negative reactions.

 

In the event that I may have additional questions or concerns regarding my treatment/service or suggested home products/post-treatment care, I will consult the esthetician and MLWB immediately.

 

I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.

 

I certify that I have read, and fully understand the above paragraphs and that I have/will have sufficient opportunity for discussion to have any questions answered.

 

I understand the procedure/service and accept the risks.

 

I will not hold the esthetician or My Little Wax Bar responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure/service, which may be affected by the treatment/service performed on the day of my service(s). 

 

By submitting this form I confirm that the above information is current and correct and I will notify my Esthetician/My Little Wax Bar if any of the above information changes prior to any future treatments that I may have at this establishment.