covid release form

Name *

First Name

Last Name

Date *

MM

DD

YYYY

I understand that, to prevent the potential risk of transmission and exposure of COVID-19, Glow & Co. Studio (the “Company”) requires all individuals attending the Premises complete complete the following questionnaire honestly and accurately. *

I Understand

Have you travelled outside Canada in the past 14 days? *

Yes

No

Have you tested positive for COVID-19 or are you awaiting for COVID-19 test results? *

Yes

No

Do you have close contact with anyone who has tested positive or is awaiting test results for COVID-19? *

Yes

No

Do you have, or are you experiencing, any of the following symptoms?

- Fever - Decrease of loss of sense of taste or smell - New onset cough - Chills - Worsening chronic cough - Headaches - Sore throat - Runny nose or nasal congestion without other known cause

Yes

No

*

If you answered “yes’ to any of the questions noted above, your access to the Premises will be denied. I fully understand that, despite the Company’s reasonable efforts to mitigate the potential transmission of COVID-19, my attendance at the Premises may result in potential transmission of the COVID-19 virus to myself, which could result in quarantine requirements, serious illness, disability and/ or death. I knowingly, freely and voluntarily accept the inherent risks of my attendance at the Premises, including, but not limited to, possible contamination, bodily injury, illness or death. In consideration of being permitted to enter the Premises, I acknowledge and agree that I will not commence litigation or otherwise seek to recover damages or other compensation against the company and its affiliates, including, but not limited to Ryann Beal, and Glow & Co. Studio and their respective officers, contractors, directors, employees based on any action, claim, loss or any recourse whatsoever arising from any potential or actual exposure to COVID-19 while attending the Premises. I further acknowledge that the company and releases can rely on this Release of Liability, Waiver of Claims and Assumption of Risk as a complete defense to any and all claims, damages, causes of action, or recourse or liability that may arise at any time. I acknowledge that I have given adequate opportunity to read and understand the Release of Liability, Waiver of Claims and Assumption of Risk, and I understand that I am signing a legal contract waiving certain legal rights, including the right to sue the Company and the Releases. I acknowledge that I am signing this Release of Liability, Waiver of Claims and Assumption of Risk voluntarily.

I Understand

Name

Typing Your name below serves as an electronic record of signature.

First Name

Last Name