Covid-19 Health Declaration

How are you feeling today?

If you did not check all 5 boxes, please go home and self isolate immediately. Contact your

health care provider or the COVID-19 info line at 1-888-364-3065. A pubic health professional

will give you detailed instructions to follow to protect you, your family, and the public.

By signing this waiver, I acknowledge the contagious nature of COVID-19 and that the CDC and

other health authorities recommend practicing social distancing. I further acknowledge that KC’s Fitness, Inc. has put in place preventive measures to reduce the spread of COVID-19 and that

KC’s Fitness cannot guarantee that I will not become infected with COVID-19.

I understand that this waiver discharges KC’s Fitness, Inc from any liability claim that I, my

heirs, or any personal representatives may have, with respect to any bodily injury, illness, death, medical treatment or property damage that may arise from, or in connection to any services received from KC’s Fitness, Inc.

Thank you.