Mar 01, 2021 07:36 PM
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 through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which DanzStar (the "Organization") adheres.
In consideration of my participation in the foregoing, the undersigned acknowledge and agree to the following:
❏ I understand that DanzStar Studio is following all precautions and disinfection practices, but due to the nature of this virus that it doesn't mean I cannot contract the virus but that it will greatly reduce my chance of it being that it is an airborne virus. I am aware of the existence of the risk of my physical appearance to the venue and my participation in the activity of Danzstar Studio may cause injury or illness such as, but not limited to, Influenza, MRSA, or COVID-19 that may lead to paralysis or death.
❏ I have not experienced the following symptoms; 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 have not, nor any member(s) of my household, traveled by sea or by air internationally within the past 14 days.
❏ I, nor any member of my household, did not visit any area within the United States that was reported to be highly affected by COVID-19, in the last 14 days.
Following the pronouncements above, I hereby declare the following:
❏ I am fully and personally responsible for my own safety and actions while a nnd during my participation, and I recognize that I may be, in any case, be at risk of contracting COVID-19.
❏ With full knowledge of the risks involved, I hereby release, waive, discharge DanzStar Studio; their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, 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 me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.
❏ I agree to indemnify, defend, and hold harmless DanzStar 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 signing this form,
I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; I am at least eighteen (18) years old and fully competent to give my consent; 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.
This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted.
By checking here, you are consenting to use of your electronic initials in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead which we can have ready for you at your next studio visit. After consent, you may request a digital or paper copy of this waiver for your records. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. *
Covid-19 Liability Release (To be completed each in person class)
By submitting, I hereby confirm that the information I have given above is true to the best of my knowledge. I understand my personal information will be kept confidential.
● I understand the above symptoms, and I affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 30 days.
● I affirm that I, as well as all household members, have not been diagnosed with COVID -19 in the last 30 days.
● I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.
● I affirm that I, as well as all household members, have not traveled in or outside of the country or by plane within the last 30 days.
● I understand that DanzStar Studio is following all precautions and disinfection practices, but due to the nature of this virus that it doesn't mean I cannot contract the virus but that it will greatly reduce my chance of it being that it is an airborne virus. I understand that DanzStar Studio cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or health history provided by each person.
● Also, I understand that DanzStar Studio has the right to refuse admittance to any person at any time, for any reason, if they feel there is a risk involved.