COVID-19 Liability Release Waiver for Clients


Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), this business is taking extra precautions with the care of every client to include health history review and enhanced sanitation disinfecting procedures in compliance with CDC guidance.


Symptoms of COVID-19 include:


Fever

Fatigue

Dry Cough

Difficulty Breathing


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 30 days.


I affirm that I, as well as all household members, have not travelled outside of the country or to any area considered to be a “hot spot” for COVID-19 infections within the past 30-days.


I understand that Robert Bartlett trading as As-Soon-As-Poss Plumber 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. I further acknowledge that Robert Bartlett can not guarantee that I will not become infected with the Coronavirus/Covid-19.


I understand that the risk of becoming exposed to and or infected by the Coronavirus COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Robert Bartlett, and his other clients and their families.


I voluntarily seek services provided by Robert Bartlett and acknowledge that I am increasing my risk to exposure to the Coronavirus COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread during my appointment.


By signing below, I agree to each statement above and release Robert Bartlett from any and all liability for unintentional exposure or harm due to COVID-19.



Sign                                                                            Date



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