COVID-19 Waiver – STAR TOWING

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COVID-19 RISK WARNING!
(Read Carefully, Mark, Fill and Sign)

Once Your Form Is Completed, You Will See A Pop-Up Message That Says...
'Your Acknowledgement Was Sent!'

If You Do Not See That Message, Then You Are Missing One Or More Form Fields.
Check And Try Again!

COVID-19
Liability Release Waiver

The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person, or through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which STAR TOWING, (the "Organization") adheres to comply.

In consideration of my participation in the foregoing activities or services, which includes the participation of contact tracing efforts with state and federal agencies, if needed, the undersigned acknowledge and agree to the following:

Please Check ALL To Acknowledge Participation ^*

I am aware of the existence of the risk on myself and my passengers for the physical appearance to the activities and my/our participation to the services of the Organization that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.

I myself have not or my passengers have not experienced symptoms that of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 14 days.

I myself have not or my passengers have not, nor any member(s) of my household, traveled by sea or by air, internationally within the past 30 days.

I myself did not or my passengers did not, nor any member of my household, visit any any area within the United States that was reported to be highly affected by COVID-19, in the last 30 days .

I myself have not been or my passengers have not been, nor any member(s) of my household, been tested for or diagnosed to be infected of COVID-19 virus within the last 30 days.

Following the pronouncements above I hereby declare the following:

Please Check ALL To Acknowledge Declaration ^*

I am fully and personally responsible for my own safety, my passengers safety and all of our actions while and during my participation, and I recognize that I may or passengers may be in any case be at risk of contracting COVID-19.

With full knowledge of the risks involved, I hereby take responsibility for myself and my passengers and release, waive, discharge the Organization, roadside assistance provider, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by myself or my passengers related to COVID-19 while participating in any service while in, on, or around the Organization or while using the recommended facilities and/or requested facilities that may lead to unintentional exposure or harm due to COVID-19.

I take responsibility for myself and my passengers, and agree to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.

By digitally signing my name below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent for myself and my passengers; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.

I understand and acknowledge that this liability release waiver will remain effective from the date acknowledged forward with no expiration.

This liability release waiver will remain effective from the date acknowledged forward with no expiration.

How Many Passengers? ^*

Please answer how many passengers in your control under the age of 18, including yourself involved in this service.

Passenger Names (Under Age of 18) ^*

Please enter the name(s) of the passenger(s) under the age of 18, that are riding in the vehicle at the time of the incident and present at the service.
Please separate names with commas.
(Ex: John Doe, Nancy Doe, Eric Doe, Sally Johnson)

First & Last Name ^*

Enter your full name.

Email ^*

This form field must have the complete email address to complete the form.
(Ex: example@startowingutah.com)

Phone ^*

Please enter the phone number with dashes.
(Ex: 801-471-7444)

Digital Acknowledgement Signature ^*

Please use your complete full name.
(Ex: John Turner Doe = First, Middle and Last)
Your digital signature here is considered legal and contractually binding.
Please enter your digital signature whether you are the owner, or the driver, of the vehicle.

Digital Acknowledgement Signature Date Of Signing ^*

Digital acknowledgement signature date of signing.
(Ex: 8-24-2014 or 8/24/2014)

Digital Acknowledgement Signature Time Of Signing ^*

Digital acknowledgement signature time of signing.
(Ex: 11:59AM or 11:59 AM)

Thank you for taking the time to fill-out our form!

Have a great day!

GET TO KNOW US

STAR TOWING is a small company based in Orem, Utah that provides Towing, Recovery & Roadside Assistance Services. We are always striving to have the latest and safest equipment for the services you are in need of. We work hard to give you competitive prices and timely responses with pride in our services, and most of all great customer service!

GET IN TOUCH

978 North 1540 West, Orem, Utah 84057
info@startowingutah.com
(801) 471-7444
Text Us Now
24/7 - Including Holidays
Utah State & DMV Registered:
Schaefer Transport & Asset Recovery, LLC
(Dba: STAR TOWING)
Impound Yard #10237

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COVID-19 Liability Release Waiver

COVID-19
Liability Release Waiver