Please state full name & relationship to the student.
Please state full name & relationship to the student.
Please state full name/s & relationship to the student.
ASSUMPTION OF RISK: By signing this agreement, I acknowledge the contagious nature of COVID-19 and on behalf of myself, my child(ren), and my spouse/co-parent of child(ren) voluntarily assume the risk that my child(ren) and I, and any member of my family, may be exposed to or infected by COVID-19 due to participating in activities at Artissima Studio and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 while at Artissima Studio may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Artissima Studio employees, independent contractors, teachers, agents and representatives, volunteers, successors, program participants and their families and/or any other individual who may be present upon Artissima Studio’s property or in attendance at any class or activity. These services are of such value to me and/or my child(ren) that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Artissima Studio’s services and premises in person. I voluntarily agree to assume, on behalf of myself, my child(ren), and my spouse/co-parent of child(ren) all risks and accept sole responsibility for any injury to my child(ren), myself and any member of my family, (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I, my child(ren) and/or members of my family may experience or incur in connection with my child(ren)’s attendance in activities at Artissima Studio (“Claims”).
WAIVER OF LAWSUIT/LIABILITY: On my behalf, and on behalf of my children and/or members of my family, I will advance no claim and I hereby release, covenant not to sue, discharge, defend, indemnify and hold harmless Artissima Studio, its employees, independent contractors, teachers, agents, volunteers, successors, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Artissima Studio, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Artissima Studio activity. I understand that this waiver means that I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages whether known or unknown, foreseen or unforeseen.
• I affirm that I understand and am aware of all Covid-19 symptoms, including but not limited to fever, chills, cough, sore throat, respiratory illness, difficulty breathing, dry cough, fatigue, or loss of taste or smell.
• I understand the COVID-19 symptoms. I affirm that neither my child, nor any member of my household, currently has or has experienced the aforementioned symptoms within the past 14 days. (fever, fatigue, difficulty breathing, dry cough or other symptoms relating to Covid-19). Furthermore, I will immediately inform Artissima Studio by email in writing (artissimastudio@gmail.com) and discontinue classes if I, or any member of my household, develops any of the aforementioned COVID-19 symptoms. My return to class will be evaluated with a physician’s note.
• I affirm that neither I, nor any member of my household, has been diagnosed with COVID-19 within the past 30 days. Furthermore, I will immediately inform Artissima Studio by email in writing (artissimastudio@gmail.com) and discontinue classes if I, or any member of my household, is diagnosed with COVID-19. My return to class will be evaluated with a physician’s note.
• I affirm that neither I, nor any member of my household, has knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days. Furthermore, I will immediately inform Artissima Studio by email in writing (artissimastudio@gmail.com) and discontinue classes if I, or any member of my household, is knowingly exposed to anyone diagnosed with COVID-19. My return to class will be evaluated with a physician’s note.
• I am following procedures and being truthful in responding to this questionnaire with respect to the overall health of our community. I understand that Artissima Studio cannot be held liable for any exposure to the COVID-19 virus caused by any misinformation on this form or the health history provided by each Student.
• I HAVE SIGNED A SEPARATE WAIVER OF LIABILITY CONNECTED WITH PARTICIPATION IN ACTIVITIES AT ARTISSIMA STUDIO. I agree that the terms of that waiver are wholly incorporated into this document and that the terms of this document are incorporated into the separate general waiver.
• I attest that my child, myself and my family practice social distancing and clean hygiene when not present on the Artissima Studio premise and during the participation in activities and classes at Artissima Studio.
I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me. I have read and understood this document and I agree to be bound by its terms.
I agree to follow procedures outlined above each week to ensure the safety of all parties.
I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RICK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE.