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COVID-19 Liability Release Waiver Clients

Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), our business is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance.

Symptoms of COVID-19 include:  Fever, 
Fatigue, 
Dry Cough, 
& Difficulty Breathing 
          

I agree to the following: 


  • I understand the above symptoms and affirm that I, as well as all household 
members, do not currently have, nor have experienced the symptoms listed above 
within the last 14 days. 


  • I affirm that I, as well as all household members, have not been diagnosed with 
COVID-19 within the past 30 days. 


  • I affirm that I, as well as all household members, have not knowingly been exposed 
to anyone diagnosed with COVID-19 within the past 30 days. 


  • I affirm that I ,as well as all house hold members, have not traveled outside of the 
country or to any city considered to be a “hot spot” for COVID-19 infections within 
the past 30-days. 


  • I understand that Terry Halsey Photography, employees, or subcontractors, cannot be held liable for any exposure 
to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.

  • 
Our business is following enhanced procedures to prevent the spread of COVID-19. 


  • By signing below, I agree to each statement above and release [name of business] from any and all liability for unintentional exposure or harm due to COVID-19. 


 

 

Name_______________________   Signature ________________________________   Date _____________

 

 

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terryhalseyphoto@gmail.com
832.248.6892
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