COVID-19 Declaration Form Your Name (required) Your Email Your Phone (required) If the answer is “yes” to any of the following questions, access to the facility will be denied. Have you had close contact ( less than 6 feet) with or cared for someone diagnosed with COVID-19 within the last 14 days? YesNoHave you been in close contact with anyone who has exhibited cold or flu-like symptoms within the last 14 days? YesNoHave you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)? YesNo By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation. This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted.