COVID-19 Release & Waiver of Liability Agreement

Due to the outbreak of the novel Coronavirus (COVID-19), [YOUR COMPANY] is taking extra precautions with the care of every customer and client. Our safety procedures include health history review and sanitation/disinfection steps, in accordance with state and federal guidelines.

Symptoms of COVID-19 include fever, fatigue, dry cough and difficulty breathing.

I understand that [YOUR COMPANY] cannot be liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.

By signing below, I agree to each statement above and release [YOUR COMPANY] from all liability for the unintentional exposure or harm due to COVID-19.

* THIS IS A SAMPLE WAIVER *

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Signee Information

First Name *

Last Name *

Email Address *

Have you or any of your household members experienced the symptoms listed below WITHIN THE LAST 14 DAYS?*

Yes

Symptoms include fever, fatigue, dry cough and difficulty breathing

Have you or anyone in your household knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 30 DAYS?*

Yes

Have you or any household members, traveled outside of the country, or to any city considered a "hot spot" for COVID-19 infections WITHIN THE PAST 30 DAYS?*

Yes

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.

COVID-19 Release & Waiver of Liability Agreement

* THIS IS A SAMPLE WAIVER *

Signee Information

Please enter participants' full names: