LIABILITY-MEDICAL-COVID19- JULY 2020/JULY 2021
Oct 27, 2021 01:19 AM
DANCE CLINIC Liability, Medical & COVID19 Release Wavier
I_________, recognize and understand the risks of physical injury inherent to dance and dance training and I fully assume those risks. I hereby release Dance Clinic its affiliates, event sponsors, employees and dance teachers from all liability for injuries sustained or illnesses contracted while attending or participating in any dance classes, rehearsals, workshops, or performances. I agree to indemnify, defend, and hold harmless Dance Clinic, event sponsors, employees and dance teachers for liabilities, costs and judgments arising from acts of omissions committed by me or my child which result in injury or damage to any person or property.
Protection of Property
I understand and agree that it is my sole responsibility to safeguard my personal property while attending or participating in any classes, rehearsals, workshops, or performances. I hereby release Dance Clinic Its event sponsors, employees and dance teachers from all liability for loss or damage to my personal property while attending or participating in classes, rehearsals, workshops, or performances. I also agree to abide by any rules, regulations and policies set forth by Dance Clinic
In case of physical injury or medical emergency, I hereby authorize Dance Clinic to make necessary arrangements to transport myself or my child to a medical treatment facility as necessary. All such transportation and medical treatment will be at my sole cost and expense. In extreme emergency, or if my child is under 18 years of age, I understand that Dance Clinic will attempt to notify the person(s) I have named as my emergency contact(s) of my condition and how to reach me.
Dance Clinic reserves the right to use photographs and videos taken during classes, workshops, performances, or other affiliated events for the purposes of instruction, advertising and promoting Dance Clinic and its programs. Students, or parents of students who are minors, who do not wish to comply with this policy must notify Dance Clinic prior to participation in class.
Please CHECK BOX if you would NOT like your child to be in any photos or media content that will be used to advertise Dance Clinic.
Acknowledgement of Waiver
In signing this Release, I acknowledge and represent that I have fully informed myself of the content of the waiver and hold harmless agreement by reading it before I sign it, and I understand that I sign this document as my own free act and deed; no oral representations, statements, or inducements, apart from the written statement, have been made. I further state that I am at least eighteen (18) years of age and am fully competent to sign this agreement; and that I execute this release for full, adequate, and complete consideration fully intending to be bound by the same. I further state that there are no health-related reasons or problems which preclude or restrict my or my child’s participation in this activity, and that I will pay any medical costs that may be attendant as a result of injury to me or my child.
I _____, knowingly and willingly consent to have my child participate in programs with Dance Clinic during the global COVID-19 pandemic. I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not with the current limits in virus testing. I confirm that MY CHILD and MEMBERS OF MY HOUSEHOLD have not in the past 14 days had any of the following symptoms of COVID-19 listed below:• Fever• Shortness of breath• Cough or any flu like symptoms including GI upset, headache, fatigue• Runny nose• Sore throat• Recent loss of taste or smellI understand that certain travel may increases risk of contracting and transmitting the COVID-19 virus. In addition, the CDC recommends social distancing of at least 6-feet for a period of 14 days to anyone who has traveled to potentially affected areas of COVID-19. Therefore, I verify that my child, nor anyone in my household, have not traveled outside the United States in the past 14-days to countries that have been affected by COVID-19. I verify that I, nor anyone in my household, have not traveled outside of Massachusetts in the past 14 days to any of the following states: New York, New Jersey, Illinois, Connecticut, Florida, and Texas (As guidelines continuously change during 2020/2021, I WILL FOLLOW the Massachusetts Laws and comply to all guidelines) I will hold harmless and indemnify, DANCE CLINIC, teachers, associates, employees, successors, assigns, legal representatives, organizers, sponsors, and supervisors, against any claims, and actions, in exchange for programs with DANCE CLINIC during this Covid-19 pandemic. Please be advised that there may be risks in being in the proximity of other people. We are taking many precautions to limit the spread of disease, yet there is still a possibility of transmission. I make this decision for my child of my own free will relying upon my knowledge and judgment 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.
Accordingly, this agreement is not an admission of any liability regarding DANCE CLINIC, teachers, associates, employees, successors, assigns, legal representatives, organizers, sponsors, and supervisors, against any claims, and actions. I have carefully read this release and understand its contents, and I am signing it of my own free act. PLEASE DO NOT send your child to the studio if they are sick or someone in your household is sick. This Covid-19 screening and consent to participate will be applied each day programs are held. Please know that for future classes and programs this written/e-form consent wavier will be in effect all year July 2020-July 2021. If you become aware that you, your child(ren) or anyone living in your household have been exposed or in contact with a positive Covid-19 person, you will immediately notify Dance Clinic. DC, might require a negative screening test to resume dance class again. I will follow all CDC guidelines while on Dance Clinic property. Massachusetts is required to wear a mask. Dance Clinic requires a mask upon entry.
If your child or someone in the home has any of the symptoms above, please do NOT send your child to studio for 24hrs. Any temperature 100.4 F or greater us considered a fever.
I understand my child can't attend Dance Clinic for 24hrs if they have a FEVER. I understand I would be putting others at risk.
If you send your child to the studio, you are consenting to this form, and stating your child and any members of the home are negative for all of the Covid-19 symptoms stated above.
If things change I'm responsible to notify Dance Clinic.