COVID-19 Liability Release Waiver

Disclaimer: The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which The Lindsay Lounge Inc. (the "Organization") adheres to comply.

Your information will remain private, this form is for contact tracing purposes as well as a Covid-19 Liability Release Waiver.

Name *

First Name Last Name

Phone Number *

Email *

example@example.com

Event Date *

Date

In consideration of my participation in the foregoing, the undersigned acknowledge and agree to the following: *

I am aware of the existence of the risk on my physical appearance to the venue and my participation to the activity of The Lindsay Lounge Inc. that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19. I have not experienced symptoms that of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 14 days. I have not, nor any member(s) of my household, traveled by sea or by air, internationally within the past 14 days. I have not been, nor any member(s) of my household, diagnosed to be infected of COVID-19 virus within the last 14 days. Me, nor any family members living in the same household or anyone I have been in close contact with within the last 14 days are not currently waiting for any COVID-19 test results.

Following the pronouncements above I hereby declare the following: *

I am fully and personally responsible for my own safety and actions while and during may participation and I recognize that I may be in any case be at risk of contracting COVID-19. With full knowledge of the risks involved, I hereby release, waive, discharge the The Lindsay Lounge Inc., its , owners, CEO, board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19. I agree to indemnify, defend, and hold harmless The Lindsay Lounge Inc. from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.

By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation. This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted.

Signature *

Clear

Date Signed *

Date