COVID-19 Waiver

Client Name *

Email Address *

Phone

Guardian NameRequired for clients 17 years old and younger.

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the Province of Ontario Health Guidelines and many other public health authorities still recommend practicing social distancing. I further acknowledge that Blood Sweat Train has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Blood Sweat Train 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, BST trainers, and other BST clients and their families. I voluntarily seek services provided by Blood Sweat Train and acknowledge that I am increasing my risk of exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my session.

I attest that I:

1) 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. *

YesNo

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

YesNo

3) I have not been diagnosed with Coronavirus/Covid-19 within the last 5 days. *

YesNo

4) I am following all Province of Ontario Health recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. *

YesNo

**IF ANY OF THE CIRCUMSTANCES ABOVE CHANGE, PLEASE CONTACT BLOOD SWEAT TRAIN IMMEDIATELY AND DO NOT ENTER THE FACILITY.

I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I also acknowledge that the Blood Sweat Train may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

Client or Guardian Signature

Guardian signature required for clients 17 years old and younger ‘