Covid-19 SCREENING QUESTIONNAIRE 

THIS SCREENING MUST BE FILLED OUT WITHIN 24 HOURS OF YOUR SESSION START TIME.

Do you believe you may, for any reason, have COVID-19?

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COVID-19 Liability Release Waiver for Clients

Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), Vuja De Studios is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance.

I, the Client, agree to the following:

• I understand the symptoms listed above and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.

• I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 30 days.

• I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days.

• I affirm that I, as well as all household members, have not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days.

• I understand that Vuja De Studios cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.

Vuja De Studios is following the enhanced procedures outlined here to prevent the spread of COVID-19.