L K DANCING

Please read tho the form been as it has been updated

Updated 03/01/2022

L K DANCING Covid-19 Health Declaration

First Name

Last Name

I/we affirm that ourselves as well as all household members, do not currently have, nor have experienced the symptoms associated with Covid-19 within the last 7 days.

I/we affirm that I/we, as well as all household members, have not been diagnosed with Covid-19 within the last 7 days and have not knowingly been exposed to anyone diagnosed with Covid-19 within the past 7 days.

I/we are aware of the risk of dancing with someone who is not a member of my household and of dancing with someone outside of my household, I/we will sanitize/wash hands before and after dancing with the person

I/We understand that L K Dancing cannot be held liable for any exposure to the Covid-19 Virus caused by misinformation on this form or health history provided by each client.

I/we agree to each statement above and release L K dancing form any and all liability for unintentional exposure or harm due to Covid-19

Initials

Date

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L K DANCING

Please read tho the form been as it has been updated

Updated 03/01/2022

L K DANCING Covid-19 Health Declaration

L K DANCING

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