COVID Release Form
In order to participate in the services offered at Empower Personalized Fitness I agree to the following:
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I will not come to the studio if I have a fever or have had any of these symptoms for last 10 days:
- Fever of greater than 100.4
- Cough
- Shortness of breath
- Difficulty breathing
- Repeated shaking with chills
- Muscle pain
- Headache
- Sore throat
- Loss of sense of smell or taste

I will not come to the studio for 10 days if I test positive for Covid-19, and I will wait to receive a negative test before returning.
I will not come to the studio if I come in close contact with someone who has been quarantined, tested or diagnosed with Covid-19 in the past 14 days.
I will maintain social distance as much as possible
**Close is defined as a) being within approximately 6 feet of a person with Covid-19 (such as caring for or visiting the patient; or sitting within 6 feet of the patient b) being coughed on, touching used tissues, etc.
Acknowledgement of Terms Agreement
I have read the preceding and acknowledge full understanding of its terms and those risks set forth herein and I knowingly agree to accept full responsibility for my own exposure to such risks and to waive full responsibility and liability on behalf of Empower Personalized Fitness L.L.C.  I understand the policies and procedures set forth by EMPOWER Personalized Fitness L.L.C. and have had the opportunity to discuss my specific needs in relation to participatory activity and, as a result, I do voluntarily request the right to participate in this preventive program of exercise.  I sign this agreement voluntarily and with full knowledge of its significance.
Client’s Name *
Date *
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