Screening Waiver for Photography Shoot

Due to the COVID-19 pandemic, Anna Keenan Photography is implementing screening measures for all individuals present on set during a shoot.

Symptoms of COVID-19 include:

• Fever

• Cough

• Runny nose

• Sore Throat

• Difficulty Breathing

• NOTE: This list is not all-inclusive as COVID-19 has a wide range of unpredictable symptoms

  I agree to the following:

• I understand the above symptoms and affirm that I, as well as all household members, do not

  currently have, nor have experienced the symptoms listed above or any other unusual or

  inexplicable health-related symptoms within the last 14 days.

• I affirm that I, as well as all household members, have not been diagnosed with COVID-19

  within the past 30 days.

• I affirm that I, as well as all household members, have not knowingly been exposed to anyone

  diagnosed with COVID-19 within the past 14 days.

• I affirm that I, as well as all household members, have not travelled internationally within the

  past 14 days.

• I understand that Anna Keenan cannot be held liable or responsible for any exposure to COVID-19 caused by misinformation on this form or the forms provided by all individuals present during the shoot.

  I understand that Anna Keenan has implemented a Health and Safety Policy with enhanced measures to help prevent the spread of COVID-19. I confirm that this Policy has been made available to me prior to the shoot and I understand my roles and responsibilities in complying with this Policy and helping to implement this Policy.

  By signing below, I agree with each statement above and release Anna Keenan Photography from any and all liability or responsibility for exposure or harm due to COVID-19.