Assumptions of Risk Waiver
By typing my name below and checking the box I agree with the following guidelines:
* I understand that the only the child receiving services can enter the facility.
* I will take my child's temperature in the presence of the therapist or give permission for the therapist to use an infrared thermometer to take my child's temperature.
* I give permission for the therapist to pick up and drop off my child from the car or at the back entrance of 163 E Main St.
* I will confirm that my child has not had a fever, shortness of breath, cough, extreme fatigue or atypical fussiness. If these symptoms arise, I will inform the therapist immediately and the session will be canceled.
* I will wear a mask at all times. If my child is able, he/she will too.
* I will coach my child on social distancing practices (ie no hugging, no touching therapist, etc.)
* I give permission for the therapist to update me via text, email or phone call. Discussion following sessions will be limited.
* I understand my appointment may be cancelled at anytime at the discretion of the therapist if the child shows any signs of illness, which could include flushed cheeks, rapid breathing or difficulty breathing (without recent physical activity), fatigue, or extreme fussiness.
* My child and I will inform our therapist if ANYONE in the home has been exposed to COVID-19 before the appointment. The session will be cancelled. It can not be rescheduled until 14 days has passed and no one is showing signs of illness.
I understand these recommendations are in the best interest of my family, my therapist's family and my community. I promise to keep open communication throughout the re-opening process.
Assumption of the Risk and 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 extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. FaithTherapyConsulting LLC, LLC has put in place preventative measures to reduce the spread of COVID-19; however, FaithTherapyConsulting LLC cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending sessions at FaithTherapyConsulting LLC could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I maybe exposed to or infected by COVID-19 by attending therapy at FaithTherapyConsulting LLC and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at FaithTherapyConsulting LLC may result from the actions, omissions, or negligence of myself and others, including, but not limited to, FaithTherapyConsulting LLC employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at FaithTherapyConsulting LLC. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless FaithTherapyConsulting LLC, its employees, agents, and representatives including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of FaithTherapyConsulting LLC, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any FaithTherapyConsulting LLC program.
