Known-COVID-19 Release

Please complete the form below, Sign and Submit.

COVID Release

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 Approved In Home Care LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Approved In Home Care LLC can not guarantee that I 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, company staff, and clients and their families. I voluntarily seek services to provide services clients of Approved In Home Care LLC that are known to be positive for COVID-19 and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my clients, and shifts. I attest that: * I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, 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/COVID-19. * I have not been diagnosed with Coronavirus/Covid-19 and not yet 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/COVID-19. I hereby release and agree to hold Approved In Home Care LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of Approved In Home Care LL, their staff, clients or that may otherwise arise in any way in connection with any services provided for the clients of Approved In Home Care LLC. Including but not limited to clients that are known to be infected and / or have tested positive for COVID-19. I understand that this release discharges Approved In Home Care LLC from any liability or claim that I, my heirs, or any personal representatives may have against Approved In Home Care LLC, staff, clients, agents or representatives with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services provided to clients of Approved In Home Care LLC. This liability waiver and release extends to the company together with all owners, partners, and employees.*
- Acknowledged and Accepted
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