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Last and First Name of student Completing this Pledge: *LAST NAME, FIRST NAME *
Are you fully vaccinated against Covid-19 including the 14 day immunity build up? *
COVID-19 INFORMED CONSENT I understand that the novel Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and may be contracted from various sources. I understand that COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious. Given the current limitations of COVID-19 virus testing, I understand determining who is infected with COVID-19 is difficult. I understand that I am the decision-maker for my health care. I will exercise caution by practicing CDC hygiene protocols and NJ self-quarantine guidelines if I travel to a state of high community transmission. I agree that I will not attend any class, private session, or event at Studio Yoga Madison if any of the following apply: (1) I have had a fever in the past 24 hours of 100*F or above; (2) I have or recently had, any respiratory or flu symptoms including fever, chills, sore throat, cough, muscle aches or shortness of breath; (3) I have been in contact with someone in the past 14 days who has been diagnosed with COVID-19 or coronavirus-type symptoms. I understand that increased ventilation and intensified sanitation protocols intended to reduce the spread of COVID-19 have been implemented. I acknowledge and assume the risk of becoming infected with COVID-19 despite the preventative measures undertaken by Studio Yoga Madison. *
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