top of page

Covid -19 & Photo Release Form

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 Build 4 Life LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that Build 4 Life 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, coaching staff, and other facility clients and their families.
I voluntarily seek services provided by Build 4 Life LLC 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 appointment.
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 Build 4 Life 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 the salon, or that may otherwise arise in any way in connection with any services received from Build 4 Life LLC. I understand that this release discharges Build 4 Life LLC from any liability or claim that I, my heirs, or any personal representatives may have against the salon 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 Build 4 Life LLC. This liability waiver and release extends to the facility together with all owners, partners, and employees.

Media release form

I hereby consent to the publication and use of my child’s name and/or my child’s likeness (“Likeness”) for the purpose of promotion, publicity, advertising, or other manner or media by Build 4 Life LLC. or any other representative authorized to act on behalf of the afore-mentioned entity. Likeness shall include, but not be limited to, photographs, sound and/or video recordings, films, broadcasts, brochures, publications, reports, web pages, promotional materials or any other audio-visual, electronic, printed, tangible work in any media or format, now known or hereafter to become known, and/or reproductions of any of these. I agree that the actual material involved is and shall continue to be the property of Build 4 Life LLC. and that neither I, nor my child, shall have any right of review or approval regarding theuse of my child’s name and/or Likeness in such material.

I hereby release and hold harmless, Build 4 Life LLC. along with their respective employees, agents, affiliates, sponsors, or other representatives from any and all claims, demands, orcauses of action arising out of the use of my child’s name and/or Likeness, in accordance with the terms of this release. I understand and agree that neither I, nor my child, will becompensated in any way for the use of my child’s name and/or Likeness by Build 4 Life LLC

Thanks for submitting!

bottom of page