PRE-SHOOT COVID-19 NOTICE & SCREENING

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Today's Date

Have you, or any one in your household, traveled outside of Canada in the last 14 days? Have you, or any one in your household, traveled outside of Canada in the last 14 days? Yes No

Do you have any of the following symptoms: fever; cough; shortness of breath or difficulty breathing; sore throat or painful swallowing; runny nose or stuffy nose or nasal congestion; feeling unwell or fatigued; gastrointestinal symptoms (nausea, vomiting, diarrhea or unexplained loss of appetite); headache or chills; unexplained loss of sense or smell or taste; unexplained muscle or joint aches? Do you have any of the following symptoms: fever; cough; shortness of breath or difficulty breathing; sore throat or painful swallowing; runny nose or stuffy nose or nasal congestion; feeling unwell or fatigued; gastrointestinal symptoms (nausea, vomiting, diarrhea or unexplained loss of appetite); headache or chills; unexplained loss of sense or smell or taste; unexplained muscle or joint aches? Yes No

Have you or anyone in your household had close unprotected contact (face-to-face contact within 2 meters/6 feet) with someone who is ill with cough and/or fever? Have you or anyone in your household had close unprotected contact (face-to-face contact within 2 meters/6 feet) with someone who is ill with cough and/or fever? Yes No

Have you or anyone in your household been in close unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? Have you or anyone in your household been in close unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? Yes No

The health information provided is true and accurate. The health information provided is true and accurate. I agree

NOTICE & WAIVER NOTICE & WAIVER I agree and understand that while the Province of Alberta has eased or eliminated various COVID-19 based restrictions on businesses, the conduct and performance of the services being provided by Toi Et Moi Photography are subject to those rules in place at the time the photography services are to be performed. I agree and understand that based upon the scope of the social distancing restrictions in place at the time of the photography services, certain aspects of the photographer/client interaction may be altered by necessity. I agree and understand that Client and any members of Client’s party assume all risks associated with potential COVID-19 transmission or exposure in relation to the photography services being provided and accept sole responsibility for an illness, injury, damages, claims or expense arising therefrom regardless of the identity of the person alleged to be at fault for such transmission or exposure. As a Client, I understand and hereby release and agree to hold Toi Et Moi Photogrpahy harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or failure to act of Toi Et Moi Photography, or that may otherwise arise in any way in connection with any services received from Toi Et Moi Photography.

SUBMISSION CONSENT SUBMISSION CONSENT By submitting this form, I acknowledge that all information is truthful. I have read, understood and agree to the terms outlined in the Notice & Waiver section above. I am at least 18 years of old and fully competent to give my consent.