Exubrancy Release of Liability and Assumption of RiskS WAIVER

I, __________  desire to participate in Exubrancy's massage, fitness, meditation and / or wellness events. I fully agree that participating in Exubrancy's services is at my own risk and I agree that I will not hold Exubrancy responsible for my own negligence or the negligence of others, including but not limited to lacerations, abrasions, contusions, musculoskeletal injuries, head injuries, disability and death. This Release covers any and all activities undertaken by me as a participant of Exubrancy's services.

Exubrancy COVID-19 INFORMED CONSENT FORM

I, __________, the undersigned participant, consent to have Exubrancy and designated affiliates (hereinafter collectively “my onsite service provider”) perform onsite wellness services, whether regarded as necessary or elective, during the time of the COVID-19 pandemic and after. I understand having my onsite service performed at this time, despite my own efforts and those of my onsite service provider, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the onsite service itself, may result in a more severe case of COVID-19 than I might have had without the onsite service.

I also understand having my onsite service performed at this time increases the risk of my transmission of COVID-19 to my onsite service provider. This virus has a long incubation period, there may be as yet unknown aspects of its transmission, and I realize that I may be contagious, whether or not I have been tested or have symptoms. To reduce the possibility of COVID-19 exposure or transmission to my onsite service provider, I accept that my onsite service provider will implement infection-control onsite services with which I must comply, before, during and after my onsite service, for my own protection as well as that of my onsite service provider. I understand my cooperation is mandatory, whether or not I personally feel such COVID-19 onsite services and/or preventive measures to be necessary.

I will inform my onsite service provider of any COVID-19 testing I or any person living with me during the past 14 days has received, as well as the results of that testing.

I confirm neither I nor any individual living with me has any of the COVID-19 symptoms listed by the Centers for Disease Control, which I have consulted; neither I nor any individual living with me during the past 14 days has experienced any such symptoms; and that I and all persons living with me for the past 14 days have practiced all personal hygiene, social distancing and other COVID-19 recommendations contained within all governmental orders issued by my city and state. I understand I must honestly disclose this information to avoid putting myself and others at risk.

All questions have been answered to my satisfaction. Being fully informed, I accept the risk of COVID-19 exposure and I will bear the cost of any COVID-19 treatments required. I have been given the opportunity to postpone my onsite service until the COVID-19 pandemic is less prevalent, but I choose to have my onsite service performed now. If I am the parent, guardian or conservator of the patient, I hold his/her health care power of attorney. I have read this COVID-19 Informed Consent Agreement and am authorized to consent on the patient's behalf.

The following information is needed for us to complete your electronic Exubrancy Release of Liability and Assumption of Risks waiver and Exubrancy COVID-19 Informed Consent Form. Please fill all required information below.