COVID-19 Release Form COVID-19 Release Form Student Name* First Last Is this form for you or your child?*Form is for me, age over 18Form is for my child, age under 18Parent or Guardian Name* First Last Email* I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Mountain SOL/Aurora Lights has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Mountain SOL/Aurora Lights can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, school staff, and other school clients and their families. I voluntarily seek services provided by Mountain SOL/Aurora Lights and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I attest that: * I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. * I have not traveled internationally within the last 14 days. * I have not traveled to a highly impacted area within the United States of America in the last 14 days. * I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. * I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities. * I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. I hereby release and agree to hold Mountain SOL/Aurora Lights harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the school, or that may otherwise arise in any way in connection with any services received from Mountain SOL/Aurora Lights. I understand that this release discharges Mountain SOL/Aurora Lights from any liability or claim that I, my heirs, or any personal representatives may have against the school with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Mountain SOL/Aurora Lights. This liability waiver and release extends to the school together with all owners, partners, and employees.Consent for COVID-19 Release* I have read this and agree to these terms.Signature*This constitutes a legally binding signature just like signing your name in person.