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The Persnickety Bride COVID-19 Questionnaire & Hold Harmless Agreement

These are uncertain times. The risks of COVID-19 are not well understood, there is controversy among experts on how the virus can spread and difficulty in scientifically determining whether anyone has the virus at any moment in time.

This form has two parts. In the first part you must answer 4 questions required by the State of Connecticut regarding whether you are sick, have been around anyone sick, or are living with anyone who is sick. If you can’t answer “No” to all four of those questions, please call contact us and we will happy to reschedule your appointment.

The second part of the form is an Indemnification/Hold Harmless agreement. By checking the box that you agree, you accept all responsibility for the risk that you may contract COVID-19. While we are taking your safety and that of our staff very seriously by employing new safety and sanitation initiatives, we cannot guarantee that any of these measures will completely protect you from contracting COVID-19

First Name

Last Name

IF YOU CAN'T ANSWER NO TO THE FOLLOWING 5 QUESTIONS, PLEASE RESCHEDULE YOUR APPOINTMENT

Have you traveled to any of the 48 states listed in Connecticut's 11/24 travel advisory within the past 14 days? Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Guam, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Puerto Rico, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virgin Islands, Virginia, Washington, West Virginia, Wisconsin, Wyoming *

COVID-19 INDEMNIFICATION/HOLD HARMLESS AGREEMENT

In consideration of receiving a haircut, color, styling or other services at Whip Salon (Whip Salon LLC, Whip Salon Westport LLC, or Tiffany’s Enterprises LLC dba Whip Salon Newtown, depending on salon location), I, for myself, my heirs, personal representatives or assigns do hereby knowingly, voluntarily, and unconditionally release, waiver, absolve, indemnify, and hold harmless Whip Salon, their officers, employees, and contractors from any and all claims or liability in any way relating to contracting COVID-19, including any and all costs and expenses incurred in the defense of such claims including court costs and attorneys’ fees.

Acknowledgment of Understanding: I have read this Agreement, fully understand its terms, and understand I’m giving up substantial rights including the right to sue. I acknowledge I am signing the agreement freely and voluntarily. I acknowledge that Whip Salon is not the only hair salon where I can have my hair services performed, that I am free to go to other salons which may not require my agreement to accept responsibility for contracting COVID-19, and that I chose to have my hair services performed at Whip Salon.

Severability: I further expressly agree that this Agreement is intended to be as broad and inclusive as is permitted by the law of the State of Connecticut and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

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