Covid19 Waiver


PLEASE TAKE TIME TO READ THE ENTIRE CONTENTS OF THIS DOCUMENT, AS IT INCLUDES INFORMATION ABOUT YOUR SAFETY AND HEALTH, AS WELL WAIVING CERTAIN RIGHTS AND CLAIMS, AS WELL AS YOUR OBLIGATIONS TO USE OUR SERVICES. WE WILL NOT PROVIDE LESSONS IF YOU DO NOT COMPLETE THIS DOCUMENTATION.

CLIENT’S FULL NAME:  

ADDRESS:

CONTACT NUMBER:

EMAIL:

 

NOTICE

Our goal is to provide a safe environment for our clients, students and staff, and to protect the health and safety of our local community.  This document provides information and serves as notice by us regarding the following subject matter: that we are a business operating under government regulations to combat the spread of the virus COVID‐19. Therefore, we ask for your respect and cooperation during these difficult times. We reserve the right to refuse service to anyone who does not comply with our safety protocols or does not practice social distancing requirements. Additionally, by completing this document you acknowledge and accept personal responsibility for providing truthful and accurate information, as well as the potential injury or harm by others by consuming our services during this time of COVID-19.

REGARDING COVID-19 AND OUR SOCIAL DISTANCING AND SAFETY PROTOCOLS

The COVID‐19 virus is a serious and highly contagious disease. The World Health Organization has classified it as a pandemic. You could contract COVID‐19 from a variety of sources. The COVID‐19 virus has a long incubation period.  While our team goes through daily temperature checks and a health screening questionnaires and checks (like the one below), determining who is infected by COVID‐19 is challenging and complicated. For these reasons there is some risk associated with glassblowing or being in any public setting at this time. We are making all reasonable effort to comply with the safety protocols put forth by the State of Hawaii and other government authorities. We wish to mitigate the risk of spreading COVID-19 and make our glassblowing facilities as safe as possible. A copy of our Glassblowing Safety Protocol has been provided to you.

However, we cannot guarantee your complete safety in not being exposed COVID-19 and we make no representations and warranties as such. Further, information on the virus changes periodically as the government updates us. Therefore, we reserve the right to update and change our Glassblowing Safety Protocol and our underlying operations based on this information.

If you are concerned about catching the virus, then please make arrangements to cancel your services, per our cancellation policy, as soon as possible. If you have questions about this form or our protocols, then please ask them prior to signing.

COVID-19 QUESTIONNAIRE

PLEASE ANSWER THE FOLLOWING QUESTIONS TRUTHFULLY

 

Do you or have you had a fever of above 100.4° in the past 14 days?

Have you recently lost or had a reduction in your sense of smell or taste?

Are you having shortness of breath or trouble breathing?

Do you have a cough?

Do you have other flu-like symptoms; such as gastrointestinal upset, headaches, or fatigue?

Have you been in contact with someone who has tested positive for or suspected they were positive for COVID-19 (corona virus) in the last two weeks?

Have you tested positive for COVID-19 or are you awaiting test results for COVID-19 within the last 10 days?

Do you have a compromised immune system in any way?

Are you over 60 years of age?

Were you tested for COVID-19 within the State Mandated 72-hour period prior to arrival in Hawaii?

Was everyone in your party tested for COVID-19 within the State Mandated 72-hour period prior to arrival in Hawaii?

 

[END OF QUESTIONS.]

 

BY SIGNING BELOW, I, THE CLIENT ACKNOWLEDGE AND ACCEPT THE FOLLOWING:

  • I have received this Notice, read, and understand its contents; 
  • I have received a copy of the company’s Glassblowing Protocols, read, and understand its contents; 
  • I understand the risks of COVID-19, including contracting it from outside sources unrelated to the company, its glassblowing services, or the company’s control over its employees or facilities; 
  • I understand that there are other customers that are utilizing the services of the company as the same time as me and shall abide by social distancing at all times; 
  • I accept these risks associated with COVID-19, including the company may change its policies based on the government’s updated information on COVID-19 and related regulations;
  • I have provided my information and answered all the COVID-19 questions in this document truthfully so that the company may rely upon their accuracy; and 
  • I, by signing below, acknowledgement and accept all the terms and conditions of this document and wish to proceed with my glassblowing lesson(s).

 

FOR PARENTS OR GUARDIANS OF MINORS

By, my signature above, I acknowledge and accept all the terms and conditions of this document for the following children receiving glassblowing lesson(s) under my care as listed below: 

List All Children Covered by this Form:

Initials of Parent/Guardian:

 

Leave this empty:

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Moana Glass By Ryan Staub https://www.moanaglass.com
Signature Certificate
Document name: Covid19 Waiver
lock iconUnique Document ID: 5c90eb45100fd2f775124626eb70ad4858ab5962
Timestamp Audit
November 2, 2020 10:35 pm HSTCovid19 Waiver Uploaded by Ryan Staub - [email protected] IP 116.105.201.147
November 5, 2020 3:20 pm HST Document owner [email protected] has handed over this document to [email protected] 2020-11-05 15:20:46 - 2001:ee0:4b79:9930:4c78:6221:974:e2af
November 5, 2020 3:57 pm HST Document owner [email protected] has handed over this document to [email protected] 2020-11-05 15:57:59 - 2001:ee0:4b79:9930:4c78:6221:974:e2af