Event: Health Screening Checkpoint

Health Screening Waiver Checkpoint
Updated 01/01/23

Hands Hands Studios are a mask-optional, not mask-free environment.

This form should only be filled out the day before your scheduled event.

If you answer “yes” to any of the following questions in the Screening Questionaire below, your child’s participation in our events (kids or adults) could unfortunately be impacted.

If you or anyone in your home has one or more symptom(s) that may be related to COVID-19, please stay home and we’ll work with you to reschedule your reservation.

Screening Waiver Questionaire

* Indicates required field

Event/Birthday Party Location *

Wilton Fairfield

Party/Event Attending *

Participant's Name *

First

Last

Participant Sibling(s)'s name(s) *

Parent/Legal Guardian *

First

Last

Preferred Phone Number *

Email *

1. Have you had anyone in your home experiencing any of the following symptoms that cannot be attributed to another health condition in the past 5 days?

Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea

1. yes or no? *

Yes No

2. Have you had anyone in your home had contact with a person known to be infected, potentially infected, or exposed to someone infected with COVID-19 within 5 days?

2. Yes or no? *

Yes No

⚠️ COVID-19 Disclaimer:
We have taken enhanced health and safety measures for all our customers and staff. You must follow all posted instructions while visiting our studio.

In any public place where people are present, there is an inherent risk of exposure to COVID-19. This is an extremely contagious disease that can potentially cause severe illness and death.

According to the Centers of Disease Control, senior citizens and those with underlying medical conditions are especially vulnerable. By visiting Happy Hands you voluntarily assume all risks related to exposure to COVID-19.

Together, we can help keep each other safe and healthy.

Agree to terms? *

I have read and agree to the follow terms and conditions.

Release Statement and Waiver of Liability:
By submitting this form, you agree to and follow the following terms and conditions. Especially during these hard time, we appreciate everyone's support.

In consideration of the Birthday Party/Event provided by the Happy Hands Art & Pottery, LLC. facilities, in which the party/event is held, I do hereby allow my child/children listed above to participate in the party/event and do hereby waive claim and release Happy Hands Art & Pottery LLC for claim or liability for any incident or accident occurring from my child’s participation in the art activities.
I authorize emergency first aid care to said child by Happy Hands Art & Pottery LLC. staff in the event he/she becomes injured or ill during the party if the parents and/or legal guardian of the child are not immediately available at the telephone numbers provided above. I further authorize Happy Hands Art & Pottery LLC. to retain the services of a physician or other competent emergency medical persons to treat the child and I accept full financial responsibility for any charges arising from said treatment.
Happy Hands Art & Pottery reserves the right to use photos or videos taken at our programs and events on our website, blog, social media or in printed materials.

Agree to terms? *

I have read and agree to the follow terms and conditions.

Signature *

Date (MM/DD/YYYY) *

Submit

Health Screening Waiver CheckpointUpdated 01/01/23

Hands Hands Studios are a mask-optional, not mask-free environment.

Screening Waiver Questionaire

Health Screening Waiver Checkpoint
Updated 01/01/23