COVID SCREENINGPlease complete this screening and liability waiver within 24 hours of our scheduled session date/time. Name * First Name Last Name Email * Phone * Country (###) ### #### Date MM DD YYYY Session Type Maternity Newborn Children Family Engagement Event Who will be included in the photos? * Please include names + ages (of kids). The Following Questions apply to you and everyone in your party/household within the last 14 days Do you have a fever of 100.4 (or higher) or a sense of fever or chills? * Yes No Do you have a cough or sore throat? Yes No Have you been exposed to anyone who has tested positive for COVID-19, or anyone you suspect to be positive? Yes No Have you been tested for COVID-19 and waiting your results? Yes No Due to the outbreak of the Coronavirus, Emily Feinsod Photography is taking extra precautions with the care of every client to include health review and enhanced sanitation efforts in compliance of the CDC guidelines. Please initial in the boxes below: I, the client, agree to the following: -I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days. -I affirm that I , as well as all household memebers, have not been diagnosed with COVID-19 within the past 30 days. * -I understand the symtoms listed above and affirm that I, as well as all of my household members, do not currently have, nor experienced any of the symtoms listed above currently or within the last 14 days. * * By typing my name below, I am electronically signing that I agree to each statement above and release Emily Feinsod Photography from any and all liability for unintentional exposure or harm due to COVID-19. Name, E-Signature * First Name Last Name Date * MM DD YYYY Thank you!
