PLEASE READ THE FOLLOWING INFORMED CONSENT CAREFULLY:
Music Together of Fairfield County, Inc. and Jacqueline Jacobs, Director, strive to provide quality music and movement instruction to and for young children and parents and/or caregivers. Music Together of Fairfield County, Inc. and Jacqueline Jacobs cannot protect your children and yourselves from unexpected illness or circumstances due to your health status. We also do not own, maintain, or guard the premises on which instruction takes place. We cannot safeguard your person or property before, during or after instruction. We hope that you will participate mindful to your health, person and surroundings. In recognition of the quality instruction we strive to provide and the fees you have and continue to pay for such services, we ask you to acknowledge the following statements for yourself and your child by signing your name at the bottom of this form.
1. A certain level of fitness may be required for participation in instruction. Each student, by and through his or her parent(s), each parent and each caregiver certify that each is in good health and has no known medical condition that could endanger their own well being or that of other adults, children, or teachers in the program. Each certifies that she/they have consulted with a physician and determined that participation does not jeopardize his/her/their health.
2. I hereby release and forever discharge Music Together of Fairfield County and/ or Jacqueline Jacobs, individually, and their respective employees, agents, assignees and other related entities, from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever arising from any and all injuries, damages or illness including exposure to contagious disease due to teacher-student proximity, parent-student proximity, or student-student proximity.
3. The premises, at which instruction is provided is not owned, inspected, maintained, or controlled by Music Together of Fairfield County Inc. and/or Jacqueline Jacobs. Each child, parent and caregiver hereby release, and for him/herself and on behalf of the student if he/she is a minor, waive and discharge Music Together of Fairfield County, Inc. and Jacqueline Jacobs, individually and their respective employees, agents, assignees and other related entities from any and all liability for any and all loss or damage and any claim for loss or damages arising from the participation or attendance at this premise, to property or per person, even injury or illness or loss or claim which arises out of the condition of the premises, whether such condition is know or unknown. Each participant inspected the location for instruction and is satisfied with the premises condition.
3. Each child, parent and caregiver or other participant in consideration for participation in the instruction provided by Music Together of Fairfield County, Inc. and Jacqueline Jacobs, individually hereby releases, and for him/herself and on behalf of the student if he/she is a minor, waives and discharges Music Together of Fairfield County, Inc. and Jacqueline Jacobs, individually and their respective employees, agents, assignees and other related entities, from any and all liability for and all loss or damage to property or to person and any claim which could not have been anticipated at the time of enrollment or any and all future MT Classes or events attended.
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. 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.
Music Together of Fairfield County Inc. has put into place preventative measures to reduce the spread of COVID- 19; however, Music Together of Fairfield County Inc. cannot guarantee that you or your child (ren) will not become infected with COVID-19. Further, attending live classes, either outdoors or indoors could increase your risk and your child(ren)’s risk of contracting COVID-19. …………………………………………………………………………………………………………………………
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Music Together of Fairfield County Inc. classes, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of become exposed to or infected by COVID-19 at a Music Together of Fairfield County Inc. class may result from actions, omissions, or negligence of myself and others, including, but not limited to, Music Together of Fairfield County owners, 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 my child( ren) or myself or my adult caregiver caregiver/ representative, ( including , but not limited to, personal injury, disability and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection to with my child(ren) attendance at a Music Together of Fairfield County Inc. class or participation in any program held by Music Together of Fairfield County Inc. On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless Music Together of Fairfield County Inc, it’s owners, employees, agents and representatives, of and from all 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 Music Together of Fairfield County Inc, it’s owners, employees, agents and representatives, whether a COVID-19 infection occurs before, during, or after any participation in any Music Together® class or program.