eWaiverPro

To keep our staff, employees and customers at this locaton safe during the COVID-19 pandemic, we require anyone entering this lcoation to answer to the following questions.

Have you or anyone in your household tested positive for COVID-19 in the last 7 days?

Have you received the vaccine?

Are you waiting for a COVID–19 test or a test result?

Have you experienced any flu-like symptoms in the last week?

Please replace this text with your question

I have answered these questions honestly and to the best of my ability.

If you answered yes to any of these questions, please provide details in the notes box below your name and notify our staff.

I am parent or guardian signing for a minor.

Employee's INFORMATION

First Name

Last Name

Phone

Date of birth (mm/dd/yyyy)

Notes

MINOR

First Name

Last Name

Date of Birth (mm/dd/yyyy)

MINOR

First Name

Last Name

Date of Birth (mm/dd/yyyy)

MINOR

First Name

Last Name

Date of Birth (mm/dd/yyyy)

MINOR

First Name

Last Name

Date of Birth (mm/dd/yyyy)

MINOR

First Name

Last Name

Date of Birth (mm/dd/yyyy)

MINOR

First Name

Last Name

Date of Birth (mm/dd/yyyy)

MINOR

First Name

Last Name

Date of Birth (mm/dd/yyyy)

MINOR

First Name

Last Name

Date of Birth (mm/dd/yyyy)

MINOR

First Name

Last Name

Date of Birth (mm/dd/yyyy)

- Delete Minor

+ Add Minor

Use your finger or stylus to
sign your name inside box

Clear and try again

USE YOUR FINGER OR STYLUS
TO INITIAL INSIDE BOX

Clear and try again

Sign Waiver

Waiver Signed for

Employee's INFORMATION

Use your finger or stylus to sign your name inside box

USE YOUR FINGER OR STYLUS TO INITIAL INSIDE BOX

Use your finger or stylus to
sign your name inside box

USE YOUR FINGER OR STYLUS
TO INITIAL INSIDE BOX