Realign Covid 19 guidelines and consent form

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Please check the box I understand to indicate you accept the guidelines. As well as answer any and all questions to the best of your ability. Sign the consent at the end.

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We will be taking temperatures upon arrival. We have the right to send anyone home that has a temperature above 99 degrees or above. They will not be able to come back unless they have no fever or symptoms of Covid 19.

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➢ Have you had a cough? ➢ Have you had a fever? ➢ Have you been around anyone exhibiting these symptoms within the past 14 days? ➢ Are you living with anyone who is sick or quarantined? ➢ Have you been in close contact with a confirmed case of COVID-19? ➢Are you experiencing a shortness of breath or sore throat? ➢Have you had a fever in the last 48 hours? ➢Have you had new loss of taste or smell? ➢Have you had vomiting or diarrhea in the last 24 hours?

Re-align sees clients by appointment only. To limit the number of persons in the gym, it is recommended that clients wait outside in their vehicle until the gym is ready to serve them. It is recommended that persons not being serviced in the gym wait outside.

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Realign will clean and disinfect all surfaces of daily use and equipment between each client. We will also provide hand sanitizer and tissues for client use.

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If you do not feel well, stay home or text me and we can set up an online appointment.

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I will try to give exercise instruction 6 ft away and cue without touching to maintain a safe social distance.

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I verify that I have not traveled outside the United States In the past 14 days to countries that have been affected by COVID-19.

Yes

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I confirm that I have or have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days.

Yes

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I understand, read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to provide the best possible experience when visiting the Realign Exercise Facility. *

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