COVID-19 Screening & Consent Form


May 16, 2021 05:16 PM



COVID-19 Screening and Consent Form


I, ________________________________, knowingly and willingly consent to have my child participate in programs with Movements In Motion Dance Studio , during the global COVID-19 pandemic. I understand that the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. I confirm that I, my child as well as all members of my household have not in the past 14 days had any of the following symptoms of COVID-19 listed : fever, shortness of breath, cough or flu like symptoms, runny nose, sore throat or recent loss of taste or smell. I also understand that certain travel may increase risk of contacting and transmitting the COVID-19 virus. Therefore, I verify that I, my child, nor anyone in my household have not traveled outside the United Sates in the past 14 days to countries that have been affected by COVID-19.

I make this decision for my child of my own free will relying upon my knowledge and judgement of any injury they may have sustained or possible transmission of COVID-19 during participation in programs and my decision to release has not been affected by any false statements or representations pertaining to those injuries. I understand that this action is my decision.

I also understand and agree to follow Movements In Motion ‘s COVID-19 Protocols as listed in the attached flyer. It is important that we follow these protocols to make sure the studio is following all CDC guidelines.

I also understand that each dancer MUST do the daily screening upon entrance and if my child has a fever of 100.5 or higher they will be sent home. I also understand that I am not permitted to send my child if they exhibit any signs of illness.

I agree to indemnify and hold harmless Movements In Motion or any of the studio’s instructors from and against any and all liabilities, claims, actions, damages, costs or expenses of any nature whatsoever, whether in law or equity, known or unknown, incurred by Movements In Motion and arising out of or in any way related directly or indirectly, to my participation in a class and/or activity and/or performance during this COVID-19 pandemic.

I agree to the terms outlined in the COVID-19 Screening and Consent Form.