COVID-19 Liability Waiver Release

All families attending our In-Person classes and our In-Person Exclusive Bubble-Cohort Classes MUST read, initial and sign this COVID-19 Liability Release Waiver form and hand it in to their instructor prior to the start of their first class.

 


Music Together of the Northern Lights, Ltd.

COVID-19 LIABILITY RELEASE WAIVER

 

 

PARTICIPATING PARENT/GUARDIAN INFORMATION:
First Name: Last Name:
 
PARTICIPATING CHILD INFORMATION:
Child's First Name: Child's Last Name:
Child's First Name: Child's Last Name:
Child's First Name: Child's Last Name:

PLEASE NOTE:
* Only one (1) adult per child is allowed to attend class, however any adult that plans to attend a class at any given time during the semester must fill out their own individual form
* If there is a legal Joint Custody Agreement involving any of the children listed above, a separate waiver MUST be filled out by EACH custodial parent/guardian regardless of intended class participation


TERMS AND CONDITIONS

 

Initial _______ I understand and agree that even with social distancing and sanitization protocols, there is a possibility of contracting the SARS-Cov-2 (Severe Acute Respiratory Syndrome coronavirus 2) virus which can lead to the COVID-19 (coronavirus) disease while attending programs at Music Together of the Northern Lights, Ltd..Therefore, I voluntarily agree to assume all risks and responsibility of contracting the SARS-Cov-2 virus, which I or any of the children listed above may contract during any Music Together of the Northern Lights, Ltd. classes or activities

Initial _______ I also exempt and release Music Together of the Northern Lights, Ltd., Music Together®, LLC and their owners, employees, sub-contractors, instructors, assistants, volunteers, location vendors, and/or program participants from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury or death to me, my children or property which may arise out of or in connection with SARS-Cov-2 and COVID-19.

Initial _______ I agree and give full consent to active symptom screenings for myself and the all children listed above which may include a temperature check.

Initial _______ I agree that myself and all participating children listed above ages 4 years of age and older will wear a mask or face covering over my nose, mouth and chin at all times upon entering in until departure from the location of my Music Together of the Northern Lights, Ltd class. (Individual exemptions MUST been discussed directly with and granted ONLY by the owner of Music Together of the Northern Lights, Ltd.)

Initial _______ On the day of each Music Together of the Northern Lights, Ltd in-person class that myself and any of the participating children listed above are to attend, before arriving to the location of my Music Together of the Northern Lights, Ltd. in-person class, I agree to perform a symptom check for myself and all participating children listed above as per the provided COVID-19 Alberta Health Daily Checklist and agree to answer the checklist truthfully and honestly to the best of my knowledge. 

Initial _______ Should I answer “YES” to any of the questions on the Alberta Health Daily Checklist for either myself or any of the participating children listed above, I agree to follow the Stay-At-Home order indicated on the COVID-19 Alberta Health Daily Checklist and NOT attend class that day.

Initial _______ I agree to alert Music Together of the Northern Lights, Ltd. of any and all medical conditions and allergies that I or any of the participating children listed above have. I understand that it is especially important to alert Music Together of the Northern Lights, Ltd. of any health conditions which may cause similar symptoms of SARS-Cov-2 and/or COVID-19. These health conditions and symptoms include but are not limited to a cough and/or shortness of breath due to asthma, and/or sore throat, runny nose and/or nasal congestion due to severe seasonal allergies

Initial _______ I agree and understand that iI will not receive a credit or refund for missed classes due to illness or adherence to the COVID-19 Alberta Health Daily Checklist Stay-at-Home order. I understand that in lieu of a credit or refund for missed classes I have access to unlimited online make-up classes throughout the semester

Initial _______ I agree and understand that if at any time gathering in groups poses a government-issued public health risk, my in-person Music Together of the Northern Lights, Ltd class will be moved online in lieu of a refund.

 

ACKNOWLEDGEMENT OF CONSENT

I am signing this waiver on my own behalf AND for the participating children listed above. I certify that I am the parent or legal guardian and have the right to waive these rights.

Parent/Legal Guardian Signature Date (mm/dd/yyyy)