Event COVID-19 Waiver: CoreShark H2O Safety Guidelines

Participant Name*

First Last

Parent / Guardian Name of Participant (if under 18)

First Last

Participant is not experiencing any symptoms 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.*

Agree
Disagree

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

Agree
Disagree

Participant has not traveled internationally within the last 14 days.*

Agree
Disagree

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

Agree
Disagree

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

Agree
Disagree

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

Agree
Disagree

COVID-19 Waiver*

I attest that I have read, understand, and accept the below provisions as a participant or parent/guardian of a participant(s).

 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 ClearShark H2O and Himmel’s Landscape and Garden Center, LLC have put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
 I further acknowledge that ClearShark H2O and Himmel’s Landscape and Garden Center, LLC cannot 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, ClearShark H2O and Himmel’s Landscape and Garden Center, LLC staff, and other clients and their families.
 I voluntarily seek services provided by ClearShark H2O and Himmel’s Landscape and Garden Center, 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 this class.

Sign This Form By Typing Your Name and Date*

Date*

Email*

COVID-19 Waiver

COVID/Coronavirus Waiver