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Coronavirus/COVID-19 acknowledgment, waiver, and liability release


As a condition of being permitted on the premises of Donald’s European Foot Care, LLC (hereinafter “DEFC LLC”)

I hereby affirm and attest to the following: (Please initial 1-5)

  1.                I and anyone in my household has not tested positive for COVID-19 or Novel Coronavirus in the last fourteen (14) days;

  2.                I and anyone in my household has not had a fever in the last seven (7) days;

  3.                In the last seven (7) days, I have not experienced any symptoms consistent with COVID-19 including: dry cough, shortness of breath, fever, body aches, more than usual fatigue or malaise; and

  4.                To the best of my knowledge, I have not had contact with anyone in the last seven (7) days who has tested positive for COVID-19 or Novel Coronavirus in the last fourteen (14) days.

  5.                I have not flown on a commercial flight in the last seven (7) days.


In consideration for receiving and service(s) from DEFC LLC, its agents, employees, and/or independent contractors, I hereby acknowledge and agree to the following:   (Please initial the following three paragraphs)

               While DEFC LLC staff is taking reasonable precautions to prevent the spread of Coronavirus, I understand and acknowledge it is impossible to guarantee staff and clients of DEFC LLC and its agents/contractors will not be exposed to Coronavirus, or that I will not contract COVID-19 as a result of such unintended exposure to Coronavirus.  I understand that Coronavirus and other viruses can be contracted by exposure to infected persons, droplets from coughs or sneezes of other persons on the premises, close proximity to persons with the virus, contact with surfaces and materials that have been touched by someone with the virus or otherwise transferred the virus, and potentially by other means.  I understand and acknowledge that a person can be infected with Novel Coronavirus and be completely asymptomatic, and that it is therefore impossible for DEFC LLC’s employees, agents and contractors to prevent anyone with the virus from being present at its premises and/or receiving services at the premises.  I acknowledge and understand that I may be exposed to novel coronavirus, the virus that causes the illness known as COVID-19, simply by being present at DEFC LLC and/or receiving services there.

               I acknowledge and understand that some services and I might receive at DEFC LLC cannot be performed when I am wearing a surgical mask or other protective mask or personal protective equipment, and that proceeding without a mask as required may increase the risk that I will be exposed to novel coronavirus and/or contract COVID-19 or other illnesses.  I understand that this is a risk inherent to the services being provided to me and any procedures performed at DEFC LLC.  These risks have been explained to me, as have the alternatives, including alternative therapies, not receiving services and/or delaying services until such time as the risks of acquiring COVID-19 from community exposure have reduced or completely subsided. I am choosing to receive services with full knowledge of the risk.


               I hereby release and hold harmless DEFC LLC, and its employees, staff, agents, and contractors from any liability arising from exposure to Novel Coronavirus or contraction of COVID- I9.  I waive any right I or my successors, heirs or devisees may have to any claim or lawsuit for money damages against DEFC LLC, its staff, employees, agents and/or contractors, arising from or related to the contraction of COVID-19 or spread of Novel Coronavirus, the virus that causes COVID-19, as a result of my presence at DEFC LLC premises or the services I received there.

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