covidwaiver

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Athlete of The Month

Daily Covid Waiver

Please complete this form prior to coming to each workout

* Indicates required field

Name *

First

Last

Cell Phone *

Email *

Today's Date *

Have you (Participant) been ill with a fever, chills, cough or body aches in the last 14 days? *

Yes NO

Has anyone in your household had these symptoms in the last 14 days? *

Yes No

Have you or anyone in your household traveled internationally in the last 14 days? *

Yes No

Have you (Participant) or anyone in your household traveled to a location in the US where an increase of incidences of COVID-19 has been reported in the last 14 days? *

Yes No

Have you (Participant) been told by a healthcare provider that you should self-quarantine due to potential COVID-19 exposure or you are suspected of having COVID-19? *

Yes No

Who is filling out this form? *

First

Last

By checking the box below, you agree that your statements are all true to the best of your knowledge *

I AGREE

Submit

.

PHONE:
(267) - 994 - 7016
EMAIL: info@peacperformance.com

Home
- about us
- Your First Visit
Programs
schedule
Testimonials
- High Intesity Training
- Athlete Training
contact
Athlete of The Month