Kneaded Experience LA Affirmation/Waiver
Email *
First Name *
Last Name *
By Clicking SUBMIT, you affirm to the following:
I, as well as all household members do not currently have, or have not experienced the symptoms of fever, fatigue, dry cough and difficulty breathing within the last 14 days.

I, as well as all household members, have not been diagnosed with COVID-19 within the last 14 days.

I, as well as all the household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 14 days.

I, as well as all the household members, have not traveled outside of the country, or to any city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within the last 14 days.

I understand that, because bodywork involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19.

I understand that this business and my therapists cannot be held liable for any exposure to the virus or any other contagion caused by misinformation or the health history provided by myself, as well as each client. This applies for all my appointments from this day forward.

By accepting my appointment, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless, the therapists and business from any claims related thereto. I give my consent to receive treatment from this therapist, this business and all other therapists at this business. I agree to each above statement and release the therapists and business from any and all liability and for the unintentional exposure or harm due to COVID-19. This applies for all my appointments from this day forward.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.