COVID-19

COVID-19 Precautionary Liability Release Form
Name

First NameLast Name
Date

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Due to the outbreak of the novel coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following and sign below.

Symptoms of COVID-19 include but are not limited to:

• Fever
• Fatigue
• Dry Cough
• Sore Throat
• Muscle Pain
• Headache
• Chills
• Difficulty Breathing
• New loss of Taste or Smell
Please check each statement to acknowledge.*

I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.I affirm that I, as well as all household members, have not been recently TESTED and are AWAITING RESULTS for COVID-19.I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the last 30 days.I affirm that I have not cared for or treated any patients suspected or confirmed to have COVID-19 within the last 30 days.I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.I affirm that I, as well as all household members, have not traveled outside of the country, or to any city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days.
Signature*

Clear

I agree that I am personally responsible for my safety and actions attending Browhaus LLC and any services rendered to myself during my visit. I agree to comply with all Browhaus LLC policies and rules, including but not limited to all Browhaus LLC policies, guidelines, signage, and instructions. Because Browhaus LLC is open for use by other individuals, I recognize that I am at higher risk of contracting COVID-19. With full awareness and appreciation of the risks involved, I, for myself and on behalf of my family, spouse, estate, heirs, executors, administrators, assigns, and personal representatives, hereby forever release, waive, discharge, and covenant not to sue Browhaus LLC, its agents, servants, independent contractors, affiliates, employees, successors, and assigns (collectively the “Released Parties”) from any and all liability, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, or injury, including death, that may be sustained by me related to COVID-19 whether caused by the negligence of the Released Parties, any third-party using Browhaus LLC, or otherwise, while participating in any activity while in, on, or around Browhaus LLC and/or while using any Browhaus LLC facilities, tools, equipment, or materials.
Signature*

Clear

I agree to indemnify, defend, and hold harmless the Released Parties from and against any and all costs, expenses, damages, claims, lawsuits, judgments, losses, and/or liabilities (including attorney fees) arising either directly or indirectly from or related to any and all claims made by or against any of the Released Parties due to bodily injury, death, loss of use, monetary loss, or any other injury from or related to my use of Browhaus LLC facilities, tools, equipment, or materials, whether caused by the negligence of the Released Parties or otherwise specifically related to COVID-19.

By signing below I acknowledge and represent that I have read the foregoing Waiver of Liability, understand it and sign it voluntarily as my own free act and deed, including without limitation the Release of Liability and Indemnification requirements contained in this document; I am sufficiently informed about the risks involved in using Browhaus LLC to decide whether to sign this document; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this document for full, adequate, and complete consideration fully intending to be bound by the same. I agree that this Wavier of Liability shall be governed by and construed in accordance with Arizona law, and that if any of the provisions hereof are found to be unenforceable, the remainder shall be enforced as fully as possible and the unenforceable provision(s) shall be deemed modified to the limited extent required to permit enforcement of the Wavier of Liability as a whole. This waiver remains in effect until the State of Arizona lifts all COVID-19 related mandates.
Signature*

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COVID-19 Precautionary Liability Release Form