Client Intake Form New Clients Step 1 of 2 50% Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Birthday MM slash DD slash YYYY How did you hear about us? Online Radio/Life 102.5 Facebook Partnership (such as Quintessa, Bergamot, Middleton Chamber, BNI, etc...) Friend Meet Your Stylist Nextdoor Other Please Specify Partnering business or affiliation* Please Specify Friend* Please specify how you heard about us* Allergies(nylon, latex, chemicals etc.) Instagram HandleCan we follow you? Additional Notes or Questions Terms of Agreement*I hereby authorize Be Inspired Salon, Inc. to perform Professional Salon Services and release Be Inspired Salon, Inc. from any and all liability. I have completed this form to the best of my knowledge. I have stated all allergies and medical conditions that I’m aware of and I will update Be Inspired Salon, Inc. of any changes to my health status. Cancellations In the event that you need to cancel or reschedule your appointment please contact us a minimum of 24-hours prior to your scheduled appointment date and time. This is simply to respect our stylists’ schedules and allows other guests to book an appointment during this time slot. Any appointments that are canceled without a 24-hour notice will be charged a cancellation fee of 50% of the scheduled service(s) total. Any appointments that are ‘no show’ will be charged 100% of the scheduled service(s) total. We have a no exception cancellation policy. This means we do not offer exceptions based on illness/COVID or weather. Unless there is a statewide or county issued snow/weather emergency, the policy charges will apply. So, please plan accordingly for travel time during Wisconsin weather seasons. Cancellation notices must be given earlier for some services such as for Bridal Packages. I agree to call a minimum of 24 hours prior to scheduled appointments to cancel my reservation. If I miss a scheduled appointment without giving a 24 hour notice, I agree to pay the missed cancellation fee that applies. I have read and agree to the Terms of Agreement Release of Liability, Indemnification, Hold Harmless, and Limitation of Warrant*We all know that these are uncertain times. The risks of COVID-19 are not well understood and there is controversy among the experts on how the virus can spread and difficultly in scientifically determining whether anyone has the virus at any moment in time. We all know that the Centers for Disease Control and Prevention has recommended that all businesses like ours remain closed. On the other hand, our Governor, Tony Evers has assessed the risk and he feels that opening salons is safe at this time. BE INSPIRED SALON, INC is not an expert in the risk analysis of COVID-19. We are willing to open and provide salon services to you if you are willing to accept the risks of contracting COVID-19. In consideration for providing hair treatment and beauty services (the “Services”) by signing below you agree to accept all responsibility for the risk that you may contract COVID-19. While we are taking your safety and that of our staff very serious, by employing new safety and sanitation initiatives, we cannot guarantee that any of these measures will completely protect you from contracting COVID-19. NOW THEREFORE, in consideration for providing the Services I agree to indemnify and hold BE INSPIRED SALON, INC, its officers, agents, servants, employees, and landowners and their successors and assigns harmless from any and all claims for damages should I contract COVID-19 from my receiving of the Services at BE INSPIRED SALON, INC. I agree that if I take any steps to make a claim for damages against BE INSPIRED SALON, INC, its agents, employees or any other released parties arising out of my receipt of the Services during my visit to BE INSPIRED SALON, INC facilities, I shall be obligated to pay all attorneys’ fees and costs incurred as a result of such claim. I acknowledge that I can go elsewhere to receive hair treatment and beauty services, and I acknowledge that BE INSPIRED SALON, INC is not the only hair salon where I can receive hair treatment and beauty services. By signing this Agreement, I acknowledge that I am free to go to other salons who may not require my agreement to accept responsibility for contracting COVID-19 and I chose to receive the Services at BE INSPIRED SALON, INC. I addition, I agree that if any dispute or claim relating in any way to the Services provided by BE INSPIRED SALON, INC pursuant to the terms of this agreement will be resolved by binding, individual arbitration, rather than in court. I agree that arbitration shall be governed by the Federal Arbitration Act (FAA), including its procedural provisions, in all respects. I have read and agree to the Release Terms Δ Please hit Next/Submit button once and as soon as you see the Thank You page your submission has gone through.