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To do our part in preventing the spread of COVID-19 in our community and workplace, we are restricting access to this facility for anyone who may have recently been exposed to the virus.  Please read carefully.

By signing below, you are affirming and attesting that:

  1. You have not in the last 14 days had any close contact with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19 (which are listed in item (3) below); AND
  2. You have not in the last month traveled to a restricted area that is under a Level 2, 3, or 4 Travel Advisory according to the U.S. State Department (including China, Italy, Iran and most of Europe); AND
  3. You do not currently experience or display, and you have not in the last 14 days experienced or displayed, any of the following symptoms:
  • Elevated temperature or fever of 100.4 or higher,
  • Cough,
  • Shortness of breath and/or difficulty breathing,
  • Loss of smell and/or taste,
  • Fatigue, muscle aches, chills, shaking, or
  • Persistent headaches.

If any of the above statements are True, you may NOT enter this building.

I understand and accept that AEI Enterprises Inc. and its affiliated entities (including 200 W Woodlawn Inc, DBD#1 Inc, DDDD, Inc, RH Social Club Rock Hill SC Inc, Leather and Lace North, Inc, TWDDD, Inc, DBLL, Inc, BLL Enterprises, Inc, B&S Enterprises Inc), executives, officers, employees and contractors cannot guarantee my safety while visiting our establishment. I promise not to seek compensation or initiate legal action against AEI Enterprises Inc., or any of the above-named entities or individuals, for any harm suffered by me in visiting this establishment.

 

First Guest Name
First Name*
Last Name*
First Guest Age Acknowledgment*
First Guest Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Guest Signature*
Second Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Third Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Fourth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Fifth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Sixth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Seventh Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Eighth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Ninth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Tenth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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