Acknowledgement of Risk for Courses with a Potentially Higher Risk of Spread of COVID - 19
PARENT OR GUARDIAN STATEMENT OF PERMISSION, APPROVAL AND ACKNOWLEDGMENT:
I the parent or legal guardian of the below-named Student do:
1. Consent to Student’s participation in the below listed class/course/activity.
2. Acknowledge that class participation is subject to various conditions and consent to those conditions, including but not limited to the following:
● Symptom checking of Student and documentation and reporting of results of such symptom checking;
● Student removal from participation if symptomatic;
● Wearing of face coverings when not actively participating;
● Social distancing measures when not participating/performing; and
● Guidelines set forth by Utah Department of Health and Salt Lake County Health Department.
LIABILITY RELEASE & INDEMNIFICATION: I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that Student and others, including myself, may be exposed to or infected by COVID-19 through participation in this unique course with higher risk of spread. In consideration of Student’s participation in the below listed class/course, I, for myself, my child, my family, my heirs, my executors and administrators, hereby voluntarily and knowingly indemnify, hold harmless, release, waive, discharge and defend RSL Academy High School and its officers, employees and volunteers from any and all suits, claims or liability, including negligence, based on any injury except those caused solely by the willful misconduct of RSL Academy High School employees. In addition, I agree that I or my insurance company will pay for medical, hospitalization, or any other expenses resulting from participation in this unique course with a higher risk of spread.
EMERGENCY TREATMENT: In case of an emergency involving Student, I hereby authorize RSL Academy High School staff to act on my behalf in accordance with their best judgment, and I agree to assume full responsibility for all expenses, medical or otherwise.
Student Full Name
Class/Course or Activity Student is participating in
Parent or Legal Guardian Name
Parent or Legal Guardian Phone Number
Parent or Legal Guardian Email Address
By signing this agreement, I the parent or legal guardian of the above-named Student acknowledge that I have read its contents, understand its contents and agree to the terms. Parent or Legal Guardian signature is required before Student is allowed to participate.
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This form was created inside of RSL academy.