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Coronavirus Liability Form

Let us do this part
Today's Date:
Tue Apr 29 2025 04:07
Coronavirus Liability Form

Due to the outbreak of coronavirus,
COVID 19, we are taking extra
precautions with the intake of each
client, health history review, as well
as sanitation and disinfecting practices.

SYMPTOMS OF COVID 19 INCLUDE:
-Fever
-Fatigue
-Dry Cough
-Sore Throat
-Muscle Pain
-Headache
-Chills
-Difficulty Breathing
-New Loss of Taste or Smell

Please initial each provision after reading.
Please read and answer
 
*
I understand the symptoms of COVID
19 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 last 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 last 30 days.
 
 
*
I affirm that I, as well as all household
members, have not traveled outside
of the country, or to any city outside
that is or has been considered a "hot spot" for COVID 19 infections within the last 30 days.
 
 
*
I understand that this business
(Lokahi Studios) and all of it's
employees can not be held liable
for any exposure to the virus or any
other contagion caused by
misinformation on this form or the
health history provided by each client.
 
 
*
I agree to each statement and release
Lokahi Studios and all of it's employees
from any and all liability for the
unintentional exposure or harm due to
COVID 19.
 
Your artist and all Lokahi Studios team
members 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.
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Client Information
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.
Name:*
Address:
Postcode:
Date of birth:*
Phone #:*
Email:*
Signature:*