COVID-19 Pre-Screening

Kids Kuts Voorhees COVID-19 Pre-Screening

We require that you fill this pre-screening out in full before you arrive for your child's appointment.

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* 1. Date your child(rens) appointment(s)

Date / Time

Date

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* 2. Name of guardian escorting the child(ren) to the appointment:

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* 3. Guardians CELL phone number

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* 4. Name of children receiving hair services:

Child 1:

Child 2:

Child 3:

Child 4:

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* 5. Has anyone in your household been diagnosed with COVID-19 in the past two weeks?

Yes

No

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* 6. Has anyone in your household shown signs or symptoms of COVID-the past two weeks?

Yes

No

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* 7. Do you agree if you, your child(ren), or anyone in your household develops any symptoms of COVID-19 within the next two weeks, you will notify Kids Kuts Voorhees at (856) 770-9292?

Agree

Disagree

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* 8. Do you agree if you, your child(ren), or any member of your household tests positive for COVID-19 within the next two weeks you will contact Kids Kuts Voorhees at (856) 770-9292?

Agree

Disagree

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* 9. Do you understand that if you report anyone in your household as having COVID-19 symptoms OR have had a positive Covid-19 test within the past two weeks you can not be permitted to enter Kids Kuts Voorhees?

Yes

No