COVID-19 Client Attestation, Studio Protocols, and Liability Waiver

COVID-19 Attestation, Protocols, & Liability Waiver Form

This is a mandatory form that must be signed and submitted electronically prior to arriving at the studio, for each class and appointment attended.
DATE *

Month Day Year
Date
NAME *

First Name Last Name
ATTESTATION *

I am not experiencing any symptom 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 taste or smell. In the past 10 days, I have not been diagnosed with Coronavirus/Covid-19 or tested positive on a covid test AND not yet cleared as non contagious according to provincial or local public health guidelines (number of symptom free days and/or via a covid test). In the past 10 days, I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. I have not traveled outside Canada in the last 14 days AND been advised to quarantine. I am not living with anyone who is CURRENTLY experiencing COVID-19 symptoms and/or waiting for test results after experiencing symptoms.
SAFETY PROTOCOLS TO EXPECT at the Studio:
- This form must be read and signed (below), and submitted electronically PRIOR to arrival at the studio. Clients who have not electronically submitted this form prior to arrival will not be permitted to enter the studio, and will be considered LATE CANCELLED as per the cancellation policy.
- Every person must arrive with a mask on, and keep it on until their class or appointment starts, at which time, they have the choice to remove their mask or keep it on.
- Upon completion of their class or appointment, each client must put their mask back on. Bandanas, handkerchiefs and scarves will NOT be considered as acceptable masks.
- Upon arrival, each client will be asked to apply hand sanitizer and take their temperature. These steps are mandatory and any client refusing to do so will be asked to leave the studio, forfeiting their class pass and being subject to a penalty as per the LATE CANCELLATION policy.
- Any client whose temperature registers above 38 degrees Celsius in two consecutive readings will be asked to leave the studio WITHOUT forfeiting their class pass or being subject to a penalty.
- Clients must arrive no less than 5 minutes prior to class start time. Any client who arrives late will not be permitted to enter the studio and join the class, and will be considered a LATE CANCEL, as per the studio cancellation policy
PLEASE READ CAREFULLY:

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that Canada's Chief Medical Officer, and the Ontario Ministry of Health and other public health authorities recommend practicing social distancing.

I further acknowledge that Nucleo Fitness Inc. has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I further acknowledge that Nucleo Fitness Inc. cannot 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, studio staff, and other studio clients and their families.

I voluntarily seek services provided by Nucleo Fitness Inc 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 class or appointment.

RELEASE of LIABILITY

I hereby release and agree to hold Nucleo Fitness Inc. 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 studio, or that may otherwise arise in any way in connection with any services received from Nucleo Fitness Inc.

I understand that this release discharges Nucleo Fitness Inc. from any liability or claim that I, my heirs, or any personal representatives may have against the studio 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 Nucleo Fitness Inc. This liability waiver and release extends to the studio together with all owners, partners, and employees.
Phone Number *

Area Code Phone Number
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COVID-19 Attestation, Protocols, & Liability Waiver Form