Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death. ClearTalk Speech and Langauge Therapy cannot prevent you or your children from becoming exposed to, contracting, or spreading COVID-19 ClearTalk Speech and Language Therapy services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize ClearTalk Speech and Language Therapy, you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize ClearTalk Speech and Language Therapy’s services. These services are of such value to me and/or my children that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize ClearTalk Speech and Langauge's services and premises in person rather than arranging for an alternative method of enjoying the same services virtually (e.g. videoconference)].
WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against ClearTalk Speech and Language Therapy and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing ClearTalk Speech and Language Therapy’s services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen. CHOICE OF LAW: I understand and agree that the law of the State of Washington will apply to this contract.
I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE,
AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING
LIABILITY AS DESCRIBED ABOVE:
To help limit the chance of exposure, we ask that you agree to the following:
1. That in the past 14 days you or anyone in your household have not had a fever, cough, breathing problems, sudden loss of taste or smell, sore throat, sneezing, or muscle aches.
2. That in the past 14 days you or anyone in your household have not traveled abroad, been on a cruise ship, or traveled within the US to an area affected by COVID-19.
3. That you have not knowingly been in contact with anyone that has a confirmed case of COVID-19.
In addition, our waiting room is closed until further notice. Therefore, to be seen, we ask that:
1. Only 1 person will be allowed in the treatment room (if the client is a minor, 1 parent or legal guardian that is not considered to be in a high-risk population can also be in the room).
2. Please wash your hands or sanitize before entering the treatment room (we have bathrooms in the back of the clinic).
Signing this document indicates that you understand the risks and agree to abide by these rules to protect yourself and protect the employees of ClearTalk Speech. Please note that if you cannot abide by these rules, you will not be able to be seen in our clinic, but can be seen online through our telehealth program. Thank you for your cooperation.