top of page

Covid-19 Health Declaration Liability Waiver

Thanks for submitting!

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.

I further acknowledge that Soul Shine has put in place preventative measures to reduce the spread of the Coronavirus /Covid 19 

I further acknowledge that Positive Vibes and Soul Shine cannot guarantee that I will not become infected with the with the Coronavirus/Covid 19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/ Covid 19 may result from the actions, omissions, or negligence of myself and others including but not limited to staff and other clients and families.

I voluntary seek services provided by Positive Vibes and acknowledge that I am increasing my risk to exposure to the Coronavirus/Covid19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.

I attest that

I am not experiencing any symptoms of illness such as cough, shortness of breath  difficulty breathing , fever, chills, repeated shaking with chills, muscle pain , headache, sore throat, or new loss of taste or smell.

I have not traveled internationally within the last 14 days 

I have not traveled to a highly impacted area within the United States of America in the last 14 days

I do not believe I have been exposed to someone with a suspected and/ or confirmed case of the Coronavirus/Covid 19 

I have not been diagnosed with Coronavirus/ Covid 19 and not yet cleared as non-contagious by state or local public health authorities

I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/Covid 19 

I hereby release and agree to hold Positive Vibes and Soul Shine harmless from , and waive on  behalf of myself , my heirs, and any personal representative any and all causes of action, claims , demands, damages, cost, expenses and compensation for damages or loss to myself and /or property that may be caused by any act or failure to act , or that may otherwise arise in any way in connection with any services received . I understand that this release discharges Positive Vibes and Soul Shine from any liability or claim that I, my heirs, or any personal representative may have against the store with respect to any bodily injury, illness, death, medical treatment or property damage that may arise from or in the connection to any services received from Positive Vibes. This liability waiver release extends to the store, together with all owners, partners and employees 

bottom of page