COVID-19 Acknowledgement of Risk and Consent Form
COVID-19 Acknowledgement of Risk and Consent Form for Guests at Bricoleur Vineyards
- The novel coronavirus (“COVID-19”) is a disease that includes several symptoms according to the Centers for Disease Control (“CDC”), such as fever or chills, cough, shortness of breath, nausea, and can lead to death. Currently, no vaccine has been developed for COVID-19. COVID-19 is contagious and means that contact with others, even those who are asymptomatic, or contact with surfaces that have been exposed to the virus, can lead to infection.
- Aware of the foregoing, I acknowledge and agree to the following terms as a condition of being allowed to enter the property of Bricoleur Vineyards.
- I understand and acknowledge the Commonwealth of California’s emergency orders, the Reopening California guidance, and the CDC guidelines regarding COVID-19. I acknowledge and understand that the circumstances regarding COVID-19 are changing from day to day and that, accordingly, state and federal orders and guidance are regularly modified and updated. I accept full responsibility for familiarizing myself with the most recent updates and complying with same at all times while on the Bricoleur Vineyards’ property.
- Bricoleur Vineyards is dedicated to providing a safe community to its staff and visitors. However, I understand that it is impossible for Bricoleur Vineyards to prevent all risk of infection. I acknowledge that Bricoleur Vineyards has done its best to implement recommended CDC, Department of Public Health, federal, state and local guidelines and put in place preventative measures to reduce the spread of COVID-19; however, Bricoleur Vineyards cannot guarantee that I will not become infected with COVID-19.
- I understand that Bricoleur Vineyards has put in place new policies and protocols in order to mitigate the spread of COVID-19. I have read and agree to abide by Bricoleur Vineyards policies and protocols for COVID-19 at all times while on Bricoleur Vineyards property.
- I acknowledge that I do not have one or more of these symptoms today or within the past 24 hours which is new or not explained by another condition:
- Fever (100.4o F/38.0 C or greater), chills, repeated shaking/shivering
- Sore throat
- Shortness of breath, difficulty breathing
- Feeling unusually weak or fatigued
- Loss of taste or smell
- Muscle or body aches
- Runny or congested nose
- Nausea or vomiting
- By signing this agreement, I acknowledge that in the last 10 days, I have not been diagnosed with COVID-19 or had a test confirming you have not been diagnosed with the virus? I also, acknowledge that in the past 14 days, I have not had “Close Contact” with someone who was diagnosed with COVID-19 or had a test confirming they have the virus while they were contagious.
I HAVE READ THIS FORM AND AGREE TO BE BOUND BY ITS TERMS BY SUBMITTING MY INFORMATION.