I, (Client Name) understand that I am opting to receive Peraonal Care Services from Leatrice Hill and staff at the Polish box.
I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person-to-person contact; and, as a result, federal and state health agencies recommend social distancing. I recognize that Leatrice Hill and staff at the Polish box are closely monitoring this situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with receipt of personal care services.
I hereby acknowledge and assume the risk of becoming infected with COVID-19 during these personal care services, and I give my express permission for Leatrice Hill and staff at the Polish box to proceed with the same.
Please Answer Questions: Yes or No (and explain if needed)