I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Amy Weisenhorn has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that Amy Weisenhorn can not guarantee that my family will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, dance studio and museum staff, and other dance and museum clients and their families.
I voluntarily seek services provided by Amy Weisenhorn and the Buena Vista Heritage Museum and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending dance classes.
I attest that:
* My family is not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* My family has not traveled internationally within the last 14 days.
* My family has not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe my family has been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* My family has not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.
* My family is following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold Amy Weisenhorn and Buena Vista Heritage Museum 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 damage or loss to myself and/or property that may be caused by any act, or failure to act, or that may otherwise arise in any way in connection with any services received from Amy Weisenhorn. I understand that this release discharges Amy Weisenhorn and Buena Vista Heritage Museum from any liability or claim that I, my heirs, or any personal representatives may have against the museum or dance program with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Amy Weisenhorn. This liability waiver and release extends to the museum together with all owners, partners, and employees.


Medical Emergency
I, the undersigned give permission to Amy Weisenhorn, to seek medical treatment for the participant in the event they are not able to reach a parent, guardian or emergency contact. I also agree that I will be responsible for any financial debt incurred by said action. I have declared on this form any physical/mental disabilities, limitations, restrictions, or condition and/or declare the participant to be in good physical and mental health.


Marketing Release- PHOTOS
Images of your child may be used for program advertising, promotional videos, website material, or various other marketing. These images will be used for dance class purposes only, and will not be given or sold to outside companies or individuals. Please speak with Amy Weisenhorn directly if you wish for your child’s photos to remain unused for these reasons.

EXCLUSION OF LIABILITY
AMY WEISENHORN, THE BUENA VISTA HERITAGE MUSEUM, THE OWNER, EMPLOYEES, OR CONTRACTORS SHALL NOT BE LIABLE FOR ANY DAMAGES OR INJURIES TO PERSONS, HOWEVER CAUSED, WHICH MIGHT BE SUSTAINED BY STUDENTS, THEIR FAMILIES, GUESTS OR OTHERS IN OUR FACILITY, OR IN ACTIVITIES WHICH MAY OCCUR DIRECTLY FROM OR INCIDENTAL TO ALL ACTIVITIES OF THIS DANCE PROGRAM. THE UNDERSIGNED PARENT OR GUARDIAN AGREES TO HOLD HARMLESS AND INDEMNIFY THE BUENA VISTA HERITAGE MUSEUM OR AMY WEISENHORN, THE OWNER, EMPLOYEES OR CONTRACTORS, WITH RESPECT TO ANY CLAIMS OF LIABILITY, PAST, PRESENT OR FUTURE, FOR ANY DAMAGE OR INJURY, OR LOSS OF LIFE TO PERSONS, HOWEVER CAUSED.
I HAVE READ THE CONDITIONS OF THIS AGREEMENT AND UNDERSTAND AND AGREE TO THE CONDITIONS SET FORTH HEREIN.