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

Symptoms of COVID-19 include and are not limited to:

• Cough
• Shortness of breath and difficulty breathing 
• Fever 
• Chills
• Muscle pain
• Sore throat
• New loss of taste or smell 

I agree to the following:

• I understand the above symptoms 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 Le Pit Club and its 3rd party partners 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. 
• I agree to wear a mask while attending Le Pit Club community events, when not eating or drinking, unless otherwise medically required.

By checking this box, I agree to each statement above and release Le Pit Club from any and all liability for unintentional exposure or harm due to COVID-19. 

(Note: If participant is a minor, please register for this event with the child’s name and email address of the participant’s parent or legal guardian)