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COVID Waiver...

Please complete before visiting in house studio if not vaccinated:

:)Not for much longer I think..(: Thank You for your support! 

 

April 26, 2024

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 TEXAS MUDDAUBER POTTERY LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.


I further acknowledge that TEXAS MUDDAUBER POTTERY LLC 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, MudDauber staff, and other MuDauber clients and their families.


I voluntarily wish to participate in classes, events, or workshops provided by TEXAS MUDDAUBER POTTERY LLC 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 while attending my class/event.

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 Agree


* I have not traveled internationally within the last 14 days.

I Agree


* I have not traveled to a highly impacted area within the United States of America in the last 14 days..

I Agree


* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. .

I Agree


* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities..

I Agree


* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19..

I Agree

 

I understand that if I am not fully vaccinated for COVID 14 days ago or more, I am required to wear a mask in studio or practice social distancing outdoors.  Hand sanitizer and hand washing opportunities will be available.


 

 

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Vaccination
I have been fully vaccinated for 14 days or more, and would like to work mask free while still observing best health practices.*
No
Yes
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*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's 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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