mindandbodyrenew.com - Covid19 Waiver

COVID-19 LIABILITY WAIVER AND RELEASE FORM
The new coronavirus is something I'm aware of. By the World Health Organization, COVID-19 has been deemed a global pandemic. And I am aware that COVID-19 is a highly contagious virus that is thought to spread through direct contact between people.

Please answer each of the following inquiries as honestly and competently as possible.
Are you currently experiencing, or have you experienced in the past 14 days, any of the following symptoms?

FeverCoughChillsFatigueHead or muscles achesShortness of breathDifficulty breathingSore throat Congestion or runny noseBody or muscle achesNew loss of taste or smellNausea, diarrhea, vomit
In the past 14 days, have you or anyone in your household traveled outside?

YesNo
Have you been tested for COVID-19 and are waiting to receive test results?

YesNo
In the past 14 days have you been in close proximately to anyone who has tested positive for COVID-19?

YesNo
RELEASE AND WAIVER

By signing this agreement. I voluntarily assume the risk that I may be exposed to or infected by COVID-19.

I hereby release and hold harmless liabilities related to COVID-19 exposure. EVEN IF ARISING FROM THE NEGLIGENCE, ACTS, OR OMISSIONS OF THE RELEASED PARTIES.
Client Name
Client Signature

Clear
Should be Empty:

COVID-19 LIABILITY WAIVER AND RELEASE FORM