I acknowledge the contagious nature of the Coronavirus / COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Empowered Sports and Fitness, LLC has put in place preventative measures to reduce the spread of the Coronavirus / COVID-19.
I further acknowledge that Empowered Sports and Fitness, LLC can not guarantee that I will not become infected with the Coronavirus / Covid19. 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, Empowered Sports and Fitness, LLC Coaches, and other clients and their families.
I voluntarily seek services provided by Empowered Sports and Fitness, LLC and acknowledge that the services may increase risk of exposure to the Coronavirus / COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
I attest that:
- I am not experiencing any symptom of illness such as cough, shortness of
breath or difficulty breathing, fever, chills, repeated shaking with chills,
muscle pain, headache, sore throat, or new loss of taste or smell.
- I have not traveled to a designated Coronavirus / COVID-19 hotspot
within the United States or Internationally, as determined by the CDC,
and / or local, state, and federal officials or agencies within the last 14
- I do not believe I have been exposed to someone with a suspected and/or
confirmed case of the Coronavirus / COVID-19.
- I have not been diagnosed with Coronavirus / COVID-19 and not yet
cleared as non contagious by state or local public health authorities.
- I am following all CDC recommended guidelines as much as possible and
limiting my exposure to the Coronavirus / COVID-19.
I hereby release and agree to hold Empowered Sports and Fitness, LLC
harmless from, and waive on behalf of myself, my heirs, and any personal
representatives any and all causes of action, claims, demands, damages,
costs, expenses and compensation for damage or loss to myself and/or
property that may be caused by any act, or failure to act of Empowered
Sports and Fitness, LLC, or that may otherwise arise in any way in
connection with any services received from Empowered Sports and
Fitness, LLC. I understand that this release discharges Empowered Sports
and Fitness, LLC from any liability or claim that I, my heirs, or any
personal representatives may have against Empowered Sports and Fitness,
LLC with respect to any bodily injury, illness, death, medical treatment, or
property damage that may arise from, or in connection to, any services
received from Empowered Sports and Fitness, LLC. This liability waiver
and release extends to Empowered Sports and Fitness, LLC together with
all owners and employees.