Covid-19 Health Screen Waiver

In compliance with the Washington State Department of Health guidelines, this form is to be completed by each adult prior to entering Safe N Sound ON THE DATE OF SCHEDULED SWIM LESSON.

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 Safe N Sound Swimming (SNS) has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19 and that I and my family members play an important role in following Safe N Sound’s COVID-19 policies and procedures.

I further acknowledge that SNS cannot guarantee that I nor my swimmer(s) will not become infected 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, SNS staff, and other clients and their families.

I voluntarily seek services provided by SNS and acknowledge that I may be increasing my risk to exposure to the Coronavirus/COVID-19, by such action. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.

I acknowledge that SNS, is to maintain the occupancy rate set by the state of Washington, and must reduce the number of clients on the pool deck. SNS is now only allowing 1 adult guardian for each swimmer. To accommodate siblings, one adult may bring more than one swimmer.

I acknowledge that SNS has the right to cancel any swim lesson based on the information received in this survey.

	I agree	I disagree
Are not experiencing any symptom of COVID-19, such as cough, shortness of breath, fever, or new loss of taste or smell.	Are not experiencing any symptom of COVID-19, such as cough, shortness of breath, fever, or new loss of taste or smell.I agree	Are not experiencing any symptom of COVID-19, such as cough, shortness of breath, fever, or new loss of taste or smell.I disagree
I, nor my swimmer(s) do not currently have a fever or 100.4 or higher.	I, nor my swimmer(s) do not currently have a fever or 100.4 or higher.I agree	I, nor my swimmer(s) do not currently have a fever or 100.4 or higher.I disagree
Have not traveled internationally nor to a highly impacted area within the past 14 days.	Have not traveled internationally nor to a highly impacted area within the past 14 days.I agree	Have not traveled internationally nor to a highly impacted area within the past 14 days.I disagree
Do not believe we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19, within 10 days of this lesson.	Do not believe we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19, within 10 days of this lesson.I agree	Do not believe we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19, within 10 days of this lesson.I disagree
Have not been diagnosed with Coronavirus/COVID-19 and not yet cleared as non-contagious by state or local public health authorities, OR have a CLEAR date from WA State Department of Health.	Have not been diagnosed with Coronavirus/COVID-19 and not yet cleared as non-contagious by state or local public health authorities, OR have a CLEAR date from WA State Department of Health.I agree	Have not been diagnosed with Coronavirus/COVID-19 and not yet cleared as non-contagious by state or local public health authorities, OR have a CLEAR date from WA State Department of Health.I disagree
Are following all CDC recommended guidelines as much as possible and limiting our exposure to Coronavirus/COVID-19.	Are following all CDC recommended guidelines as much as possible and limiting our exposure to Coronavirus/COVID-19.I agree	Are following all CDC recommended guidelines as much as possible and limiting our exposure to Coronavirus/COVID-19.I disagree