COVID-19 Health Screen, Liability Release & Waiver
The World Health Organization (WHO) and the United States Center for Disease Control and Prevention (CDC) have declared the novel Coronavirus (COVID-19) a pandemic. Due to its capacity to transmit from person-to-person, the CDC has published recommendations, guidelines, and restrictions which Solace Holdings, LLC d/b/a Solace New York (Solace) has implemented for the safety of its customers and staff.

In order to use the facilities at Solace New York, you must answer YES to all questions in this form.
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I acknowledge the contagious nature of COVID-19 and that the CDC and many other public health authorities recommend practicing social distancing.  I further acknowledge that Solace has put in place preventative measures to reduce the spread of COVID-19 including sanitizing the furniture, rest rooms, equipment and facilities; requiring social distancing and masks to be worn; requiring customers and staff to successfully answer a questionnaire regarding potential systems and contact tracing prior to entering the facilities and taking the temperature of customers and staff before being admitted to the facilities. *
I further acknowledge that Solace cannot guarantee that I will not become infected with the COVID-19. I understand and voluntarily accept the risk of becoming exposed to and/or becoming infected by COVID-19 as a result of entering and using Solace’s facilities. I agree to comply with all procedures and requests by Solace to prevent and reduce the spread COVID-19 while present in Solace’s facilities. *
I acknowledge that I have had no COVID-19 symptoms in the past 14 days (including but not limited to cough, shortness of breath or difficulty breathing, fatigue, fever, chills, muscle pain, diarrhea, vomiting, headache, sore throat, or new loss of taste or smell). *
I acknowledge that I have not received a positive COVID-19 diagnostic test in the past 14 days. *
I acknowledge that I have had no close contact with a confirmed or suspected COVID-19 case in the past 14 days. *
I acknowledge that I have not traveled out of NY state in the past 10 days or, if I have, I hate met the NYS requirements to leave quarrantine. *
I acknowledge that if I have tested positive for COVID-19 in the past, I have recovered and have been cleared as non-contagious by state or local public health authorities. *
I agree to indemnify Solace and its officers, owners, managers, directors, staff, agents and representatives from any cost, liability, damage or expense incurred as a result of my misrepresentation of any of the above statements. *
I hereby release, waive, discharge and covenant not to sue Solace, its officers, owners, managers, directors, staff, agents and representatives from any and all liability of whatever kind or nature, in law, equity or otherwise, and for any and all present or future loss or damage, including any claims, causes of action, liabilities and expenses (including attorneys’ fees), that may arise from my contracting COVID-19 from the unintentional exposure to COVID-19 at Solace’s facilities. *
In the event that I do not fill out this form immediately before a future visit to Solace New York, I affirm that I will only enter the facility if my answers to the above questions remain permissible (all YES). *
Please type your name below to affirm that the information you have given in this form is true to the best of your knowledge. *
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