Name:

- I acknowledge the contagious nature of the Coronavirus/ COVID19 and that the CDC and many other public health authorities still recommend practicing social distancing.
- I further acknowledge that Dallas Uplift Fitness has put in place preventative measures to reduce the spread of the Coronavirus/COVID19.
- I further acknowledge that Dallas Uplift Fitness can not guarantee that I will not become infected with the Coronavirus/COVID19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID19 may result from the actions, omissions, or negligence of myself and others, including but not limited to facility staff, and other facility clients and their families.
- I voluntarily seek services provided by Dallas Uplift Fitness and acknowledge that I am increasing my risk 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, or difficulty breathing. Fever, chills, muscle pain, headaches, 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/COVID19.

- I have not been diagnosed with Coronavirus/COVID19 and have not yet been 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/COVID19

I hereby release and agree to hold Dallas Uplift Fitness harmless from and waive on behalf of myself, and my heirs and any personal representative any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damage or loss to myself and/or property by any act, or failure to act of the Facility/Gym, or that may otherwise arise in any way in connection with any services received from Dallas Uplift Fitness. I understand that this release discharges Dallas Uplift Fitness from any liability or claim that I, my heirs, or any personal representatives, may have against the facility/gym with respect to any bodily injury, illness, death medical treatment, or property damage that may arise from, or in connection to, any services received from Dallas Uplift Fitness. This liability waiver and release extend to the facility/gym together with all owners, partners, and employees.

Client Signature

Date