Assumption of the Risk and Waiver of Liability Relating to 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. Connect Plus Therapy has put in place preventative measures, following the guidelines of the CDC, to reduce the spread of COVID-19; however, we cannot guarantee that your child will not become infected with COVID-19. Further, participation could increase your child’s risk of contracting COVID-19.
Please Read Carefully before signing and initial each paragraph.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child may be exposed to or infected by COVID-19 when attending sessions provided by Connect Plus Therapy; and that such exposure or infection may result in personal injury, illness, permanent disability, and death to my child and, by extension, to my child’s contacts, including, but not limited to, myself and (other) members of my child’s immediate and extended family, friends, acquaintances and other individuals with whom my child may come into contact, whether directly or indirectly.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child or contacts (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that my child or contacts may experience or incur in connection with my child’s participation in services. On my child’s behalf, I hereby release, covenant not to sue, discharge, or hold harm against Connect Plus Therapy, the company’s employees, stakeholders, and representatives, of and from any and 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 and omissions of Connect Plus Therapy, its employees, stakeholders, and representatives, whether a COVID-19 infection occurs before, during, or after participation in services.
By signing this document, I agree that if my child or contacts is exposed or infected by COVID-19 during the participation in services, then we may be found by a court of law to have waived the right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.
I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that if I were to choose not to sign this release, services may be able to continue one on one. I have read and understood this document and I agree to be bound by its terms.
We are agreeing to continue to provide services to your child within in-home settings until events render us unable to. This agreement does not guarantee services and does not override any orders that may come from the CDC, Governor, or other governing body. This agreement and the terms of this agreement may change at any time as this situation continues to evolve. In the event that we are no longer able to provide in person services, we will work with you to provide suggested strategies and guidance on managing problem behavior. We will also offer video conferencing services (telehealth services) from our Board Certified Behavior Analyst if your insurance payor allows such services.
These events render us unable to continue services:
- Not following the guidelines
- Any member of the household coming into contact with a confirmed case of COVID-19
- Any member of the household showing signs of COVID-19 as outlined by the CDC (fever, cough, shortness of breath, etc.)
- Any member of the household has a fever or 100.4 or higher
- Federal or State Agencies prohibit services
I have read and understand the above listed terms and acknowledge that I voluntarily sign this document.