COVID-19 Self-Screening Registration & Waiver
The safety of our dancers and staff remains the primary concern of My Dance Studio Inc. As the coronavirus (COVID-19) outbreak continues to evolve, the My Dance Studio Inc is monitoring the situation closely and will periodically update guidance on current recommendations from the Center for Disease control and the World Health Organization.

To help prevent the spread of COVID-19 and reduce the potential risk of exposure to our dance community we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone each day as you come to the studio. Thank you for your time and cooperation!

1) Dancers must maintain social distancing 6 ft at all times
2) Groups will not exceed 14 individuals (teachers and dancers combined) outdoors and 7 individuals indoors.
3) Bring a water bottle
4) Do not share equipment or water
5) Bathroom use will be available but limited
6) Dancers must arrive wearing a mask and masks must be worn indoors at all times
7) Dancers are encouraged to shower and wash their dance clothing as soon as they return home

Vulnerable individuals should not supervise or participate in any studio activities for the safety of themselves.

All dancers must fill out this questionnaire before they can attend classes.


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

My Dance Studio,Inc., from here on known as MDS, has put in place preventative measures to reduce the spread of COVID-19; however, MDS cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending MDS could increase your risk and your child(ren)’s risk of contracting COVID-19.
Please feel free to consult with your lawyer regarding this document which may affect your legal rights.

By accepting 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 classes at My Dance 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 the studio may result from the actions, omissions, or negligence of myself and others, including, but not limited to, MDS employees, contractors, 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, 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 with my child(ren)’s attendance at MDS practice or participation in MDS programming (“Claims”).

On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless My Dance Studio, Inc., it’s employees, contractors, 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 MDS, its employees, contractors, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any MDS classes and programs.
Name of Dancer(s) *
I understand and agree that if my dancer(s) is experiencing COVID-19 symptoms, including cough, respiratory illness, sore throat, shortness of breath, fever or any other cold/flu symptoms they cannot attend classes. *
I understand and agree that my dancer(s) cannot attend class if they or anyone in their household has had close contact with anyone diagnosed with COVID-19 within the last 14 days? *
I understand and agree that if my dancer(s) or anyone in their household is traveling, the studio MUST be notified. Additionally, if my dancer(s) or a member of their household travels by plane or to a high-risk area they will not be permitted to attend classes for 7-14 days. *
I agree to immediately notify the studio and update this form if anything changes in relation to COVID-19 exposure of either dancer or anyone in their immediate household. *
By typing my name below I am accepting the terms and agreements of both the MDS COVID Waiver and the MDS COVID Procedures and Guidelines and agree to adhere by such guidelines and understand that the failure to do so will result in the immediate dismissal of my dancer from MDS without a refund. *
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