Kidzone COVID-19 Release Form

1
Age of Consent* This field is required.In the case of a Minor, this form must be filled and submitted by a Parent or Legal Guardian.
I am an Adult over the age of Eighteen (18).
The Student is a Minor under the age of Eighteen (18).
2
Check off what you are participating in:* This field is required.Please select at least one of the options.
Birthday Party
Tiny Tumble Monday 4:45
JR Prep/Level 1 Monday 6pm
JR Prep/Level 1 Thursday 5pm
Ninja Kidz Monday 7:15
JR Prep/Level 1 Tuesday 4:30
Level 3 Tuesday 3:30
Southern Youth Cheer Tumbling Wed. 5pm
Southern Youth Cheer Practice Wed. 6pm
Level 2 Thursday 6:15
3
Minor Student's Name in FullPlease enter the Minor's name in full.
Given Name
Family Name
4
COVID-19 Common Symptoms, as per WHO:

Fever

Dry Cough

Tiredness
5
I agree to the following:* This field is required.You must agree to and select All of the statements.
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 Furor 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 Furor 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 Furor 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 Furor 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 the Furor 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.
6
I agree to the following:You must agree to and select All of the statements.
I understand the aforementioned COVID-19 symptoms.
I affirm that neither the Student, nor any member of our household, currently has or has experienced the aforementioned symptoms within the past 14 days. Furthermore, I will immediately inform Furor and discontinue classes if the Student, or any member of our household, develops any of the aforementioned symptoms.
I affirm that neither the Student, nor any member of our household, has been diagnosed with COVID-19 within the past 30 days. Furthermore, I will immediately inform Furor and discontinue classes if the Student, or any member of our household, is diagnosed with COVID-19.
I affirm that neither the Student, nor any member of our household, has knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days. Furthermore, I will immediately inform Furor and discontinue classes if the Student, or any member of our household, is knowingly exposed to anyone diagnosed with COVID-19.
I affirm that neither the Student, nor any member of our 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 Furor and discontinue classes once the Student, or any member of our household, returns from traveling outside of the country or to any city considered to be a "hot spot" for COVID-19 infections.
I confirm that I am the Parent or Legal Guardian of the Student.
I understand that the Furor 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.
Any legal disputes with the Furor will be subject to Bangalore Jurisdiction.
7
Furor 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 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 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 in the reception area and other locations within the premises.

We are requesting that each of our students, please…

Allow us to check their temperature before entering the premises to ensure it is below 38.0°C.

Wear a face mask at all times within the building and within the studio.

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 Furor from any and all liability for the unintentional exposure or harm due to COVID-19.

Furor agrees to abide by these standards and affirms the same.
8
Student's Name in Full* This field is required.Please enter your name in full.
Given Name
Family Name
9
Parent or Guardian's Name in FullPlease enter your name in full.
Given Name
Family Name
10
Mobile Number* This field is required.Please enter the Mobile Number registered to WhatsApp, if available.
Do not include "0" or "+91"
11
Email ID* This field is required.Please enter your Email Address.
example@example.com
12
Signature* This field is required.Please sign the form.
ClearPlease sign above
13
DateForm submission date.
Date of Submission
Day
Month
Year
Should be Empty: