• I agree to follow all facility policies, procedures, and instructions during my visit.
• I will wear a visitor badge at all times while on premises and return it before leaving.
• I will remain only in approved areas and will not access restricted zones without authorization.

• I confirm I am not experiencing symptoms of illness such as fever, cough, sore throat, or shortness of breath.
• I understand the facility cannot guarantee protection from COVID-19 exposure despite safety protocols.
• I assume all risk related to potential exposure to COVID-19 during my visit, including transmission to or from residents, staff, or other visitors.
• I agree to comply with the facility’s infection control policies, including masking, distancing, and hygiene.

With full knowledge of the risks involved, I hereby release and hold harmless the facility, its parent companies, employees, and agents from all claims, demands, and causes of action related to COVID-19 exposure or illness arising from my visit.

• I acknowledge that my biometric data (e.g., facial image) may be collected and used by the facility’s visitor management system for secure screening and access.
• I understand this data will not be sold or shared, and I have the option to request a non-biometric check-in method.
• I release Advanced Entry, LLC from any liability related to the storage and use of my biometric data.

• I understand that resident information is confidential under HIPAA.
• I will not take photos, videos, or disclose resident health information without proper consent.

I agree not to disclose or misuse any confidential information, procedures, or operations I may observe while on site. This includes but is not limited to resident information, internal protocols, staff practices, or proprietary technology.

• I will not give residents any cigarettes, drugs, medications, cash, or valuables.
• I will not leave the premises with a resident without notifying the front desk.
• I understand that failure to comply with these rules may result in immediate removal and/or permanent revocation of visitation privileges.

By signing below, I confirm that I have read, understood, and agree to all terms outlined above.

• I am at least 18 years old and competent to provide this acknowledgment.

Name: ________________________________________
Signature: ____________________________________
Date: ________________