Please check each of the boxes below, by checking each box you are agreeing to the following statements:
Original Moxie, LLC is doing everything to protect you, our client, our community, and our staff. To this extent, we will be following the Center of Disease Control (CDC) and local health department guidelines with regard to social distancing practices and sanitation in order to reduce the spread of Novel Coronavirus, or COVID-19.
By signing and submitting this form, you agree to comply with the written instructions above and agree that you are at the salon at your own risk, releasing Original Moxie from any liability relating to COVID-19.
Electronic Signature and Acknowledgement
Enter the date and your full name to acknowledge your electronic signature of this document.
Your Electronic Signature*
*Fully vaccinated means it has been two weeks since your second dose of the Moderna or Pfizer Covid-19 Vaccine or two weeks since your first and final dose of the Johnson & Johnson Covid-19 Vaccine.