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Covid-19 Liability Waiver

COVID-19 Liability Waiver

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 Clare Hesterman has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I further acknowledge that Clare Hesterman 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, studio staff, and other studio clients and their families.

 I voluntarily seek services provided by Clare Hesterman 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 appointment or class.

I attest that:

I am not experiencing any symptoms of COVID-19 such as fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, in the last 14 days.
I do not believe I have been in close contact to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19 in the past 14 days.
I have not tested positive for Coronavirus/Covid-19 in the past 14 days.
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 Clare Hesterman 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 the studio, or that may otherwise arise in any way in connection with any services received from Clare Hesterman.  I understand that this release discharges Clare Hesterman from any liability or claim that I, my heirs, or any personal representatives may have against the studio 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 Clare Hesterman. This liability waiver and release extends to the studio together with all owners and partners.

First Clients Name
First Name*
Middle Name
Last Name*
Phone*
First Clients Date of Birth*
Date of Birth
First Clients Signature*
Second Clients Name
First Name*
Middle Name
Last Name*
Clients Date of Birth*
Date of Birth
Third Clients Name
First Name*
Middle Name
Last Name*
Clients Date of Birth*
Date of Birth
Fourth Clients Name
First Name*
Middle Name
Last Name*
Clients Date of Birth*
Date of Birth
Fifth Clients Name
First Name*
Middle Name
Last Name*
Clients Date of Birth*
Date of Birth
Sixth Clients Name
First Name*
Middle Name
Last Name*
Clients Date of Birth*
Date of Birth
Seventh Clients Name
First Name*
Middle Name
Last Name*
Clients Date of Birth*
Date of Birth
Eighth Clients Name
First Name*
Middle Name
Last Name*
Clients Date of Birth*
Date of Birth
Ninth Clients Name
First Name*
Middle Name
Last Name*
Clients Date of Birth*
Date of Birth
Tenth Clients Name
First Name*
Middle Name
Last Name*
Clients 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*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
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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