COVID-19 Pandemic Consent Form
Please take a moment to complete the consent form. By submitting the form below you agree to knowingly and willingly consenting to have services at The Archery during the COVID-19 pandemic. The Archery has the right to refuse service if this form is not submitted. Thank you.
Name
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First Name
Last Name
Date
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Month
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Day
Year
Date
I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not, given the current limits in virus testing.
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Yes
I confirm that I am not presenting any of the following symptoms of COVID-19 listed below: • Temperature above 98.7 degrees • Shortness of breath • Loss of sense of taste or smell • Dry cough or sore throat
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Yes
I confirm that I have not been around anyone with these symptoms in the past 14 days.
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Yes
I do not live with anyone who is sick or quarantined.
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Yes
To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the studio’s strict guidelines.
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Yes
To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the studio’s strict guidelines.
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Yes
I agree to allow The Archery to take my temperature through a non-contact device.
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Yes
I confirm that I have not traveled outside the United States in the past 14 days to countries that have been affected by COVID-19.
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Yes
I understand that if at any point in the future I can say yes to these questions, it is my responsibility to notify my service provider.
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Yes
I understand The Archery/my service provider cannot be held liable for any exposure to this virus or any other contagion as I have decided to come here on my own free will.
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Yes
Signature
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Submit
Should be Empty: