COVID 19 Waiver

COVID-19 Liability Release Waiver

**Signature Required Prior to Every Scheduled Appointment**

Due to the current outbreak of COVID-19, Movement Studios LLC is taking extra precautions to ensure the health of every client by requiring a health history review and enhanced sanitation/disinfection procedures in accordance with professional industry and government guidance.

Symptoms of COVID-19 include:

Fever
Fatigue
Dry Cough
Difficulty Breathing
Muscle or Body Aches
Headache
New Loss of Taste or Smell
Sore Throat
Congestion or Runny Nose
Nausea or Vomiting
Diarrhea

I agree to the following*: *

I understand the above symptoms and affirm that I, 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 I, as well as all household members, have not been diagnosed with COVID-19 WITHIN THE PAST 30 DAYS. I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 14 DAYS.

I affirm that I, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 14 DAYS.

I understand that Nancy Latuja and Movement Studios LLC cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.

Movement Studios LLC is following these enhanced procedures to prevent the spread of COVID-19:

- All surfaces will be sprayed with disinfectant before and after each client, according to manufacturer’s directions
- Prepayment for services available for contactless checkout
- Additional time included between appointments to prevent client contact with each other
- Guests accompanying those scheduled for services discouraged
- Each client required to have temperature taken with a touchless thermometer upon arrival
- Each client required to wash hands or use hand sanitizer upon arrival and before leaving
- Your instructor will thoroughly clean hands before and after each session
- Clients and instructors required to wear face masks and grip socks
- For dance classes, all students are required to wear face masks and proper dance shoes (heels, ballet slippers, etc.)

By submitting this form, I agree to each statement above and release Nancy Latuja and Movement Studios LLC from any and all liability for the unintentional exposure or harm due to COVID-19.

Nancy Latuja and all independent contractors agree to abide by these standards and affirms the same.

Name *

Date *

email *