Wellness Waiver (Rick's Studio)
Completion of the following waiver is required prior to every on-site activity (including private lessons, recordings or classes)
INSTRUCTIONS:
Students 18+--Please complete the form prior to your on-site lesson on the day of the lesson
Students 18 and under--A parent/guardian must complete the form prior to the on-site lesson on the same day as the lesson
**If the waiver isn't completed by the time the student is dropped off, a paper waiver will have to be completed at MO by the student or the parent/guardian. If you complete a paper waiver, please email Erika prior to your lesson to send written consent for taking on-site lessons during our COVID advisory.
* Required
Email address
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Your email
Date+Time of Lesson
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Your answer
Student Name
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Your answer
Name and relation to student if filled out by parent/guardian
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Your answer
Please respond YES or NO to the following questions:
Is the student feeling feverish or had chills or shaking chills?
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YES
NO
Does the student have a cough, sore throat, or trouble breathing?
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YES
NO
Does the student have muscle aches or a new/unusual headache?
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YES
NO
Does the student notice a new loss of taste or loss of smell?
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YES
NO
Does the student have abdominal, pain, vomiting, diarrhea)?
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YES
NO
Is anyone in the student's household displaying any symptoms of COVID-19?
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YES
NO
To the best of your knowledge, has the student or anyone in their household come into close contact (1 Close contacts include household contacts, intimate contacts, or contacts within 6-ft. for 15 minutes or longer) with anyone who has tested positive for COVID-19?
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YES
NO
Please select the option that best describes yourself or your student:
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I have none of the above symptoms or contacts
I have at least one of the above symptoms or contacts
ATTESTATION: I attest to the truthfulness of this form (PLEASE ENTER INITIALS)
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Your answer
If you answered Yes to one or more of the above wellness check questions: DO NOT COME TO THE MUSICAL OFFERING. PLEASE GO HOME, AND CONTACT YOUR PHYSICIAN. CONTACT YOUR TEACHER RE REMOTE LESSON.
To submit written consent please type your FIRST and LAST Name: "I understand that the Musical Offering is recommending that all classes and lessons go remote during the 30 day COVID advisory that went into effect Nov. 17th, or be put on hold for 30 days if remote is not an option. By participating in activity on-site at The Musical Offering including private lessons, classes or recordings, I understand the risks and I understand that I am choosing to learn on-site even with the advisory in place and with other options available. By signing, I am giving written consent to learn on-site (or for my student to learn on-site if the student is 18 and under).
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Your answer
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