Events Covid-19 Waiver | Artissima Studio

Student's name: *

What event are you attending at Artissima? *

xxxx's Birthday party, xxxx workshop, etc

Date of the Event: *

Emergency Contact + Responsibility

Primary Emergency Contact: *

Please state full name & relationship to the student.

Phone # of Primary Emergency Contact: *

Medical Information

Does your child have any allergies, medical conditions, or special needs that Artissima needs to be aware of? *

If yes, please specify:

Photo Release

We would like to record all of the fun studio activities!

I agree to grant Artissima Studio and its authorized representatives permission to take photographs or record video of my child/the student and/or his or her artwork. I further agree that any or all material may be used for documentation of studio work and for promotional purposes of Artissima Studio in any format, which may include digital and print advertisements, newsletters, brochures, publications, and on social media. Furthermore, such use of material shall be without payment of fees, royalties, special credit or other compensation. *

Yes- I authorize Photo Release
No - I do not authorize Photo Release

Limitation of Liability

I certify that I am a Parent/Guardian of this minor, and I have enrolled the minor in an art class conducted by cclstudio LLC d/b/a ARTISSIMA (“Artissima”). I understand that the art class will include art activities and use of materials that could cause property damage, personal injury, or illness resulting from misconduct during art-related activities and misuse of materials. I consent to pulling my minor from class participation without reimbursement if my minor is disruptive and risks injury to other participants. I also agree to drop off and pick up my minor at assigned start and finish class times. As part of my agreement with Artissima to enroll in the art class, I hereby agree, to the fullest extent allowed by law, to RELEASE ANY AND ALL CLAIMS I MAY HAVE against Artissima, their owners, managers, members, contractors, employees and other representatives (hereinafter, “Agreement Beneficiary”) relating to or arising out of any property damage, personal injury or illness the minor may incur while attending or participating in the art class and on the business premises. Under no circumstances shall the studio be liable to you, your child/children or any third party for any indirect, consequential, incidental, punitive, special or similar damages or costs. I certify that I have read this Agreement, I have discussed it with the minor participant, and I agree to its terms and conditions. *

I agree

Signature *

Please sign your full name.

Date *

Covid-19 Declaration Form and Release

**Signature Required Prior to Attending Art Class** Cclstudio LLC DBA Artissima and anyone else involved in the operations of the studio's premises, including but not limited to, the owner, the instructors, independent contractors, volunteers, visiting faculty and staff (are hereinafter referred to as "Artissima Studio” or “Artissima").

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. Artissima Studio has put in place preventative measures to reduce the spread of COVID-19; however, Artissima Studio. cannot guarantee that your child(ren) will not become infected with COVID-19. Further, participation could increase the risk of contracting COVID-19 for you and your child(ren).

Assumption of Risk *

I have read the statement below

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: *

I have read the statement below

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.

By signing below, I agree to each statement above and release Artissima Studio from any and all liability for the unintentional exposure or harm due to COVID-19.

Screening Questionnaire:

Following the pronouncements above, I hereby declare the following:

Covid-19 *

I understand and agree to the below statements

• 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.

Symptom Check *

I understand and agree to the below statements

I understand the COVID-19 symptoms. • If my child or any member of our household experiences the aforementioned symptoms of COVID-19 prior to the event at Artissima Studio, I will either provide a negative test result and follow the CDC guidelines OR I will not attend the event at Artissima.

Exposure to COVID-19 *

I understand and agree to the below statements

I affirm that neither I, nor any member of my household, has knowingly been exposed to anyone diagnosed with COVID-19 in the last 10 days. OR We have been exposed, but we are following the CDC guidelines and will still be able to attend the event. Furthermore, if I or members of my household have an exposure prior to the event at Artissima (after filling out this form), we will follow the suggested CDC guidelines. If there is not time to properly quarantine before the event, we will not attend the event.

COVID-19 Testing *

We have not tested positive for COVID-19 • I affirm that neither I, nor any member of my household, has had symptoms or has been diagnosed with COVID-19 within the past 10 days. Furthermore, If I or any member of my household is diagnosed with COVID-19 after filling out this form, I will make sure that I follow the current CDC guidelines. If there is not time to properly quarantine before the event, I will not attend the event.
We have tested positive for Covid in the past 10 days, but we have followed the CDC guidelines, and we will be able to attend the event • I affirm that I OR members of my household have tested positive for COVID-19 in the last 10 days, but we have followed the current CDC guidelines regarding the appropriate quarantine after receiving a positive COVID-19 test. We have had no symptoms for the CDC appointed amount of time, and we will be able to attend the event. Furthermore, If I or any member of my household is diagnosed with COVID-19 after filling out this form, I will make sure that I follow the current CDC guidelines. If there is not time to properly quarantine before the event, I will not attend the event.

Please check one of these boxes.

I am being truthful in presenting this information *

I understand and agree to the below statements

• 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.

General Liability *

I understand and agree to the below statements

• 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.

Procedures for our students

We are requesting that each of our students, please… • Bring aprons or wear clothing appropriate for a mess. Artissima Studio will not be providing aprons. • Take your Temperature: Parent Guardian will take child’s temperature at home before entering the premises to ensure that it is below 100.4 F. If you arrive at class, it is assumed that you have taken your temperature • Wear a face mask at all times within the building and within the studio.

Procedure for Students *

I have read and will implement the procedure

I agree to follow procedures outlined above each week to ensure the safety of all parties.

I have read and fully understand the provisions of this release form *

I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE. I agree to be bound by its terms, and I understand that this activity might not be made available to me.

Student's Name *

First

Last

Parent/Guardian Name *

First

Last

Signature of Student (if above 18) or of Parent/Guardian *

Date *