COVID-19 Disclaimer (Consent Form)


Oct 20, 2020 08:51 PM



INFORMED CONSENT FOR IN-PERSON SERVICES DURING COVID-19 PUBLIC HEALTH CRISIS

Thank you for your trust in Mrs. Jenkins Dance Academy. As with the transmission of any communicable disease like a cold or the flu, you may be exposed to COVID-19, also known as Coronavirus at any time or place.

This disclaimer contains important information about our decision (yours and mine) to resume dance lessons in light of the COVID-19 public health crisis. Please read this carefully and let me know if you have any questions. By completing registration and taking classes, it will be an official agreement between us.

Risks of Participating in Dance Lessons
You understand that by coming to the dance studio, you are assuming the risk of exposure to the coronavirus (or other public health risk). This risk may increase if you travel by public transportation, cab, or ridesharing service.

Your Responsibility to Minimize Your Exposure
To obtain services in person, you agree to take certain precautions which will help keep everyone (you, me, and our families, [my other staff] and other dancers) safer from exposure, sickness and possible death. If you do not adhere to these safeguards, it may result in our returning to virtual dance lessons.
• Your dancer will only attend dance lessons if he/she is symptom free.
• You will take your dancer’s temperature before attending each dance lesson. If it is elevated (100 Fahrenheit or more), or if he/she have other symptoms of the coronavirus, you agree to contact MJDA to alert us of your absence.
• You will drop your dancer off at the door with MJDA Staff and wait until temperature is taken. Your dancer may not be dropped off no earlier than 5 minutes before his/her class time.
• Your dancer will use alcohol-based hand sanitizer when he/she enters the building.
• You will adhere to the MJDA COVID-10 Prevention Plan and safe distancing precautions we have set in place, even when you are away from MJDA.
• You will wear a mask in all areas of the MJDA including the parking lot (I [and MJDA staff] will too).
• You will keep a distance of 6 feet while waiting outside or in the parking lot and there will be no physical contact (e.g. no shaking hands) with me [or staff].
• You and your dancer will try not to touch your face or eyes with your hands. If you do, you will immediately wash or sanitize your hands.
• You will make sure that your child follows all of these sanitation and distancing protocols.
• If you have a job that exposes you to other people who are infected, you will immediately contact MJDA to let us know.
• If your commute or other responsibilities or activities put you in close contact with others (beyond your family), you will take the appropriate steps to either quarantine, heath screen, or self-check to ensure you are free of any illness.
• If a resident of your home tests positive for the infection, you will immediately let MJDA know and we will then plan virtual lessons for your dancer until after 14 or more days of quarantine (2 weeks or more of virtual dance lessons).

MJDA may change the above precautions if additional local, state or federal orders or guidelines are published. If that happens, we will talk about any necessary changes.

MJDA’s Commitment to Minimize Exposure
MJDA has taken steps to reduce the risk of spreading the coronavirus within the studio and we have posted our efforts on our website and in the dance studio. Please let Mrs. Jenkins know if you have questions about these efforts.

If You or Anyone at MJDA Are Sick
You understand that we are committed to keeping you, me, [MJDA staff] and all of our families safe from the spread of this virus. If you or your dancer show up for dance classes and after having his/her temperature taken, shows signs of fever or other symptoms, or believe you have been exposed, we will have to require you and your dancer to leave the studio immediately.

If I [or MJDA staff] test positive for the coronavirus, we will notify you so that you can take appropriate precautions.

Your Confidentiality in the Case of Infection
If you or your dancer have tested positive for the coronavirus, I may be required to notify local health authorities that you have been in the dance studio. If I have to report this, I will only provide the minimum information necessary for their data collection. By completing registration and taking classes, you are agreeing that I may do so without an additional signed release.

Informed Consent
This agreement supplements the general informed consent/business agreement that we agreed to at the start of our work together.