COVID-19 Liability Waiver

COVID-19 Liability Waiver

Please read carefully, and complete this Waiver within 24 hours of your appointment. This Waiver MUST be submitted in order to receive services.
Date *

Month Day Year
Date
Name *

First Name Last Name
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Crystal McLain Creative, LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I further acknowledge that Crystal McLain Creative, LLC does not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, David Presutte (onsite resident), and other clients and their families.

I voluntarily seek services provided by Crystal McLain Creative, LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
I ATTEST THAT: *

I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of tase or smell. * I have not traveled internationally or out of state within the last 14 days. * I do not believe I have had been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19 * I have not been diagnosed with Coronavirus/COVID-19 and not yet cleared as non contagious by state or local public health authorities. * I am following CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold Crystal McLain Creative, LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the Massage Practice of Crystal McLain Creative, LLC, or that may otherwise arise in any way in connection with any services received from Crystal McLain Creative, LLC. I understand that this release discharges Crystal McLain Creative, LLC from any liability or claim that I, my heirs, or any personal representatives may have against the Massage Practice of Crystal McLain Creative, LLC with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Crystal McLain Creative, LLC. This liability waiver and release extends to the Massage Practice together with David Presutte.
Name *

First Name Last Name
Email *
example@example.com
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