And-Co COVID-19 Disclaimer & Liability Release

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

Symptoms of COVID-19 include:
- Fever
- Fatigue/tiredeness
- Dry cough
- Difficulty breathing
- Aches & pains
- Sore throat
- Conjunctivitis
- Diarrhea
- Headache
- Loss of taste or smell
- A rash on skin, or discolouration of fingers or toes
- Chest pain or pressure
- Loss of speech or movement

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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 30 days.

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I affirm that: *

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

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

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.

Required

I understand that: *

And-Co/Arpeg Holdings Ltd 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.

Required

By signing below, I agree to each statement above and release And-Co/Arpeg Holdings Ltd from any and all liability for unintentional exposure or harm due to COVID-19.

Your first and last name: *

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