COVID-19 Release Waiver
Date *
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Name *
Phone Number *
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. *
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I further acknowledge that The Innovation Hub has put into place additional preventive measures, beyond that required by state directive/health department regulation, to reduce the potential spread of coronavirus/COVID-19. *
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I further acknowledge that neither The Innovation Hub nor any staff member can guarantee that I will not become infected with the coronavirus/COVID-19. *
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I am voluntarily entering the Innovation Hub and seeking services provided by The Innovation Hub and acknowledge that I am increasing my risk of exposure to the coronavirus/COVID-19 by doing so. *
Required
I agree to comply with all precautions and protective measures set forth by The Innovation Hub; including but not limited to wearing a face mask, at all times during my time at The Innovation Hub. *
Required
I agree to hold The Innovation Hub (including all staff) harmless if I do contract any disease or illness due to my presence at The Hub, including but not limited to coronavirus/COVID-19. *
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I attest that I am not currently experiencing any symptoms of coronavirus/COVID-19 such as cough, fever, shortness of breath or difficulty breathing, chills, muscle soreness, sore throat, or loss of taste of smell, nor have I experienced any of the above symptoms in the past 14 days. *
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By checking this box, I affirm that these statements are true and this box authenticates my signature. *
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