COVID-19 Declaration Form & Release (Furor)

COVID-19 Declaration Form and Release

**Signature Required Prior to Resuming Dance Classes**
K-Star Academy

and anyone else involved in the operations of the studio's premises, including but not limited to, instructors, visiting faculty and staff (are hereinafter referred to as "K-Star Academy").
Age of Consent*

I am an Adult over the age of Eighteen (18).The Student is a Minor under the age of Eighteen (18).
What and With Whom are you learning?*

Musical theatre classes for age groups 4-12 yearsSenior drama only classStaff member at K-Star AcademyOther
Minor Student's Name in Full

Given NameFamily Name
COVID-19 Common Symptoms, as per WHO:
- Fever
- Dry Cough
- Tiredness
I agree to the following:*

I understand the aforementioned COVID-19 symptoms.I affirm that neither I, nor any member of my household, currently has or has experienced the aforementioned symptoms within the past 14 days. Furthermore, I will immediately inform K-Star Academy and discontinue classes if I, or any member of my household, develops any of the aforementioned symptoms.I affirm that neither I, nor any member of my household, has been diagnosed with COVID-19 within the past 30 days. Furthermore, I will immediately inform K-Star Academy and discontinue classes if I, or any member of my household, is diagnosed with COVID-19.I affirm that neither I, nor any member of my household, has knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days. Furthermore, I will immediately inform K-Star Academy and discontinue classes if I, or any member of my household, is knowingly exposed to anyone diagnosed with COVID-19.I affirm that neither I, nor any member of my household, 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. Furthermore, I will immediately inform K-Star Academy and discontinue classes once I, or any member of my household, returns from traveling outside of the country or to any city considered to be a "hot spot" for COVID-19 infections.I understand that K-Star Academy cannot be held liable for any exposure to the COVID-19 virus caused by any misinformation on this form or the health history provided by each Student.I agree to comply with the COVID-19 prevention procedures at K-Star Academy.
K-Star Academy will be adhering to the following enhanced procedures to prevent the spread of COVID-19.

Our instructors and staff will…
- Do a temperature check before entering the studio, and ensure that it is below 38.0°C.
- Clean/Disinfect frequently touched surfaces thoroughly and at regular intervals.
- Wash/Sanitize our hands before and after each session.
- Wear our masks/visors at all times.
- Maintain a safe distance at all times.
- Accommodate a limited number of students in each class to ensure physical distancing.
- Schedule classes 15 mins apart so as to allow time for cleaning/disinfecting surfaces and allow students to finish and leave the studio before the next set of students arrive.
- Provide sanitizers on entering the premises.
We are requesting that each of our students, please…
- Ensure they are not feeling unwell and do not have a high temperature before coming to class.
- Allow us to check their temperature before entering the premises to ensure it is below 38.0°C.
- Maintain a safe distance from others at all times.
- Use the hand sanitizer before entering and while exiting the studio.
- Carry their own bottle or cup for drinking water.
By signing below, I agree to each statement above and release K-Star Academy from any and all liability for the unintentional exposure or harm due to COVID-19.

K-Star Academy agrees to abide by these standards and affirms the same.
Student's Name in Full*

Given NameFamily Name
Parent or Guardian's Name in Full

Given NameFamily Name
Mobile Number*
Do not include "0" or "+91"
Email ID*

Confirmation Emailexample@example.com
Signature*

Clear
Please sign above
Date

DayMonthYear
Date of Submission
Should be Empty:

COVID-19 Declaration Form and Release

K-Star Academy