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COVID Waiver Form

I verify that my child

is a client of Just Us Swim Kids LLC for survival swim services.

I consent to prescribed survival swim services in my home setting and or at an agreed upon facility during the COVID-19 pandemic. I understand the risk that this is a community infection with the possibility of asymptomatic transmission and will hold harmless and will not assert any claim for compensation against my survival swim instructor, Just Us Swim Kids LLC and/or the facilities used if COVID-19 exposure occurs for any reason.

I will verify that no one in my household (including baby sitters) is experiencing any of the following: diarrhea, vomiting, fever, cough, congestion or has experienced any of these symptoms for the last 14 days of each date of service. I will verify that I have had no known exposure to any person who has been diagnosed with COVID-19 in the last 14 days for each date of service.

I will let my provider know PRIOR to arrival to my home or services provided at one of the agreed upon locations if anyone in the household is experiencing any of the above symptoms or has had a known direct exposure to COVID-19 within the last 14 days.

Thanks for submitting!

Please make sure that you already completed the other REQUIRED FORMS:

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