COVID-19 Liability Release Waiver

COVID-19 Liability Release Waiver

**Signature Required Prior to Attending Buttercup**
Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), Buttercup Pole Dance, LLC is taking extra precautions with the care of every client with enhanced sanitation/disinfection procedures in accordance with CDC's Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes.

https://www.cdc.gov/coronavirus/2019-ncov/community/reopen-guidance.html

Symptoms of COVID-19 include:
- Fever
- Fatique
- Dry Cough
- Difficulty Breathing
I agree to the following:*

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 diagnosed with COVID-19 WITHIN THE PAST 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 PAST 30 DAYS.I affirm that I, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 DAYS.I understand that Buttercup Pole Dance, LLC cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.I agree to abide by the rules and guidelines put in place by Buttercup Pole Dance, LLC for my safety and for the safety of others. Those not following guidelines will be asked to leave class.
Buttercup Pole Dance, LLC is following these enhanced procedures to prevent the spread of COVID-19:
- Prepayment for services thorugh the Mindbody app or desktop site.
- Additional time included between appointments to prevent client contact with eachother
- Each client required to wash hands upon arrival and before leaving
- Your instructor will thoroughly clean hands before and after each class.
- Your instructor will wear a mask to teach. Students are required to wear a mask upon entry and during class.
- Each pole will have 1 alcohol bottle, and 1 rag. Dispose of the rag when finishing class in the hamper, and place the alcohol bottles in the middle of the floor for disinfecting by instructor.
- All floors will be mopped with bleach mixture and surfaces wiped with disinfectant before and after each class according to the manufacturer's directions.
By signing below, I agree to each statement above and release Buttercup Pole Dance, LLC and it's staff and instructors from any and all liability for the unintentional exposure or harm due to COVID-19.

Buttercup Pole Dance, LLC agrees to abide by these standards and affirms the same.
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