Due to the 2020 outbreak of the Novel Coronavirus, COVID-19, we are taking extra precautions with the intake of each member, as well as sanitation and disinfection practices. Please complete the following and sign below.
Symptoms of COVID-19 include:
- Fever
- Fatigue
- Dry Cough
- Difficulty Breathing
I agree to the following:
I understand the above symptoms and affirm that my child, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.
I affirm that my child, as well as all household members, have not been diagnosed with COVID-19 within the last 30 days.
I affirm that my child, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.
I affirm that my child, as well as all household members, have not traveled outside of the country, or to any town/city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days.
I understand that this business cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form.
By signing below, I agree to each above statement and release the Rosen JCC from any and all liability for the unintentional exposure or harm due to COVID-19.
The employees of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.