COVID-19 ACKNOWLEDGEMENT
Apr 27, 2024 07:05 AM
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is a disease that causes symptoms such as fever, chills, cough, shortness of breath, nausea, and can lead to death. COVID-19 is highly contagious and is believed to spread in a variety of ways, including through person-to-person contact. Contact with other people, even those who show no symptoms, as well as contact with surfaces that have been exposed to the virus, may lead to infection. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing, wearing a mask, and hand washing or using hand sanitizer.
Dance Academies in Massachusetts have been authorized to open their facilities for programing beginning in phase three of the Governor’s Re-Opening Plan. Although CLDA has taken steps to try to reduce the risk of transmission of COVID-19 at its facility, it is not possible to eliminate any possibility of transmission. Accordingly, there is a risk that someone coming to our academy will contract COVID-19 while present at the facility. Coming to and being present at the Cultura Latina Dance Academy can increase your risk of contracting COVID-19.
By signing this acknowledgement, you acknowledge that you understand: (1) the contagious nature of COVID-19, (2) the fact that it can be difficult to identify in another person, and (3) the inherent risk of exposure while attending in person classes. You acknowledge that you may be exposed to or infected by COVID-19 through your attendance and that such exposure may result in personal injury, illness, permanent disability, or death. By signing this form, you acknowledge and assume these risks and confirm that you are voluntarily choosing to attend in person lessons at Cultura Latina Dance Academy. By signing this acknowledgement, you agree to abide by all guidelines that CLDA has implemented to help reduce the risk of transmission, including social distancing, wearing a mask and frequent hand sanitizing.
By signing this acknowledgement, you also consent to submit and comply with any testing, health monitoring, or contact tracing protocols that CLDA may determine are prudent to maintain a safe environment for its attendees and staff. You understand that CLDA will take reasonable steps to ensure the confidential and private nature of the testing and health monitoring information it may obtain from you. However, you understand and agree that Cultura Latina Dance Academy may share your COVID-19 related information with certain employees, health care providers, and/or public health officials with a legitimate need to know this information.
I HAVE READ THIS FORM. I HAVE HAD AN OPPORTUNITY TO ASK QUESTIONS, AND THEY HAVE BEEN ANSWERED TO MY SATISFACTION. I UNDERSTAND THE CONTENT OF THIS FORM AND AGREE TO BE BOUND BY ITS TERMS.