COVID-19 Release of Liability Waiver

Cough
- Shortness of breath or difficulty breathing
- Chills
- Repeated shaking with chills
- Muscle pain
- Headache
- Sore throat
- Loss of taste or smell
- Diarrhea
- Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit
- Known close contact with a person who is lab
confirmed to have COVID-19

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 River City Massage School and my therapist, 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 understand that due to the nature of the service I am receiving, the CDC-recommended six-foot distance between myself and my therapist cannot be maintained. I also understand that failure to practice social distancing elevates the risk of becoming infected.

Caadm Enterprise, DBA River City Massage School is following these enhanced procedures to prevent the spread of COVID-19:

Prepayment for services available if clients prefer contactless checkout

Additional time included between appointments to prevent guest contact with each other

Guests accompanying those scheduled for services are not permitted

Each guest is required to wash hands upon arrival and before leaving

Your Therapist will thoroughly clean hands prior to and following your visit.

All surfaces will be wiped thoroughly with hospital grade disinfectant before and after each client according to the manufacturer's directions, and sterilized in accordance with Texas Department of Regulations guidelines.
All staff and customers are screened each day for symptoms and fevers.

By signing below, I agree to each statement above and release River City Massage School, as well as my therapist from any and all liability for the unintentional exposure or harm due to COVID-19.

Date

Signature *

Clear

Name

First Name Last Name

Phone Number *

Area Code Phone Number

Email

example@example.com