COVID-19 Liability Release Waiver
Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), Professional Tutoring is taking precautions with the care of every client to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC and state guidance.
Symptoms of COVID-19 include:
• Fever or chills
• Dry cough
• Shortness of breath or difficulty breathing
I agree to the following:
- I understand the above symptoms and affirm that neither my student (or “I,” if over 18 years old) nor any household member is currently experiencing or has experienced the symptoms listed above within the last 14 days.
- I affirm that neither my student (I) nor any household member has been diagnosed with COVID-19 within the past 30 days.
- I affirm that neither my student (I) nor any household member has knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days.
- I affirm that neither my student (I) nor any household member has traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days.
- I affirm that I will notify Professional Tutoring if my student (I) or any household member is experiencing any of the symptoms listed above, or if any of the previously-described situations apply to me at any point while using Professional Tutoring’s services.
- I understand that Professional Tutoring cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.
Our business is following these enhanced procedures to prevent the spread of COVID-19:
• Requiring students to use hand sanitizer or wash their hands upon entry
• Requiring all staff members and students to have face masks
• Sanitizing surfaces (tables, counters, doorknobs, bathroom) before and after each session
• Providing virtual options (Zoom or Facetime) to all students, and requiring students to switch to one of these virtual options if they have any symptoms, or if any of the situations described above apply to them.
By signing below, I agree to each statement above and release Professional Tutoring from any and all liability for unintentional exposure or harm due to COVID-19.
Please type in your NAME to agree to the Terms and Conditions of this Agreement. By typing your name and selecting the "Submit" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "Submit" you consent to be legally bound by this Agreement's terms and conditions. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and Professional Tutoring. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. Thank you.
Send me a copy of my response.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service