Client Health Certification

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In order for us to see you for in-person sessions at our studio, please INITIAL and SIGN the following Health Certification.

Reminders: If you have any of the symptoms or potential exposures listed below on the day of each facility visit, we ask that you stay home and wait 10 days before returning to the facility.

If you have traveled by plane, train or have visited a county with higher numbers per 100,000 population than Ada County and are NOT vaccinated against COVID-19, we ask that you stay home and wait 10 days, or 7 days if a negative test was taken at 5 days post-travel, before returning to the facility. Vaccinated clients do not need to quarantine.

Please reference our full Studio Safety Protocol at https://thrivepilates.com/covid-19-studio-safety-protocol/ for details on self-monitoring for these symptoms and potential exposures, and alternatives for in-person sessions.

This form only needs to be submitted one time. By submitting this form you agree to the above requirements, and that you will ensure all parameters below are met prior to each in-studio visit.

In consideration of my use of the facilities of Pilates at Thrive, LLC (“Thrive”), I certify the following conditions ON THE DAY OF EACH FACILITY VISIT:

(Form last updated: 5/14/2021)

I do not have a temperature that exceeds 100.4 degrees. (Please initial below.) *

I have not had a fever in excess of 100.4 degrees at any time in the last 72 hours without the use of fever-reducing medicine. (Please initial below.) *

I am not experiencing a cough, shortness of breath, or other common symptoms of COVID-19 that are not attributable to another known health condition that I am unable to transmit to others. (Please initial below.) *

In the past 10 days, I have not had close contact with someone who has a confirmed case of COVID-19 or symptoms of COVID-19. (Please initial below.) *

In the past 10 days, I have not traveled domestically to any counties identified by the CDC and/or WHO as having a greater number of cases per 100,000 residents than that of Ada County. (Please initial below.) *

I understand that my use of Thrive’s facilities is conditioned on these certifications. *

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Printed Name: *

Digital Signature: *

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