ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19 Fields marked with an * are required 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. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. High Priestess Pole Studio has put in place preventative measures to reduce the spread of COVID-19; however, High Priestess Pole Studio cannot guarantee that you will not become infected with COVID-19. Further, attending classes at High Priestess Pole Studio could increase your risk of contracting COVID-19. These Safe Space prevention measures were clearly explained to me. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending High Priestess Pole 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 at High Priestess Pole Studio may result from the actions, omissions, or negligence of myself and others, including, but not limited to, High Priestess Pole Studio employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at High Priestess Pole Studio or participation in the studio classes (“Claims”). On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless High Priestess Pole Studio, its employees, agents, 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 High Priestess Pole Studio, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any High Priestess Pole Studio class or activity. I certify that I am 18 years of age or older. Electronic Signature Consent By checking here, you are consenting to use of your electronic initials in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead which we can have ready for you at your next studio visit. After consent, you may request a digital or paper copy of this waiver for you records. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent.
