READ CAREFULLY – THIS AFFECTS YOUR LEGAL RIGHTS
You must complete this form for each student that will be attending Parrott Academy in August.
Our state and county is experiencing a Novel Coronavirus (hereinafter COVID-19) pandemic, and a public health emergency has been declared for North Carolina. COVID-19 is extremely contagious, and can be spread in many ways, including person-to-person contact or between persons in close proximity. The purpose of this form is to obtain your consent, on your own behalf and your family’s behalf, to voluntarily attend and participate in on-campus classes and/or any other school related activities and functions at Arendell Parrott Academy (hereinafter APA), and your agreement to release and hold harmless APA and its trustees, officers, administrators, teachers, staff, employees, volunteers, contractors, agents, and representatives (hereinafter collectively Associates) from any and all liability directly or indirectly related to any physical and mental injury, damage, disability or death from exposure to COVID-19.
The undersigned hereby covenants and agrees not to bring any claims, demands, lawsuits or causes of action for any reason related to COVID-19 exposure against APA and/or Associates resulting from participation/attendance at on-campus classes or other school related activities and functions, or while using any APA facilities in connection with any such classes, activities, or functions.
Currently, there is some increased risk associated with attending on-campus classes or other school related activities and functions. These risks include:
- Exposure to others who may have the virus
- Exposure to facilities that contain the virus
Patients in the following categories and with the following health conditions are at greater risk:
- Chronic lung disease
- Serious heart disease/conditions
- Chronic kidney disease
- Severe obesity
- Age 65 or older
- Nursing home or long-term care facility residents
- Immunocompromised or immune suppressed patients
- Liver disease
If you have one or more of these problems, you may be at greater risk for contracting COVID-19. If you contract COVID-19, you may be at greater risk to develop complications, including serious complications possibly leading to hospitalization and, in rare situations, death.
*APA has put in place reasonable measures to reduce the spread of COVID-19; however, APA cannot guarantee that you, your child(ren) or other family members will not become infected with COVID-19
Agreements and Acknowledgments
In exchange for my child(ren)’s or ward’s ability to voluntarily attend on-campus classes and/or other school related activities and functions, for myself and (if applicable) for the members of my family (including any person for whom I am the legal, personal or responsible guardian), I make the following agreements and acknowledgments:
- I agree and acknowledge that it is my responsibility to provide for my own health and safety.
- I agree and acknowledge that it is my responsibility to provide for the health and safety of my child(ren) or any person(s) for which I am the legal or personal guardian who may participate in and/or attend on-campus classes, or attend any other school related activities or functions.
- I assume all risk and harm associated with any potential exposure to COVID-19 that I may have, or any members of my family may have, due to participating/attending on-campus classes or other school related activities and functions.
- I agree and acknowledge that APA and Associates are not responsible for any exposure I have, or any members of my family may have, to COVID-19 during my or my family member’s participation in and/or attendance at on-campus classes or other school related activities or functions, or while on the premises of APA.
- I agree and covenant not to sue APA and Associates for any damages, costs or expenses of any kind related to or arising out of my or my family’s exposure to or infection from COVID-19.
- I agree and understand that the risk of becoming exposed to or infected by COVID-19 at APA may result from the actions, inactions, omissions, or negligence of myself or others, including but not limited to, APA and Associates.
- I agree and understand this Consent: Waiver and Release includes any potential claims, demands, lawsuits or legal causes of action based on the actions, inactions, omissions, or negligence of APA and Associates, or other students, participants and attendees, whether the COVID-19 exposure or infection occurs before, during, or after participation in an APA related activity or function.
- I agree and acknowledge that although APA and/or Associates have made reasonable attempts to protect students, participants and attendees from COVID-19, it is my duty and responsibility to follow Centers for Disease Control (CDC) and local health guidelines for social distancing and other measures to reduce the spread of COVID-19, and to ensure that my child(ren) or ward(s) follow such guidelines and measures as well.
- I agree, and my family members agree, to maintain six (6) feet of distance between us and any other student, participant or attendee to the extent possible.
- I agree that if I feel unsafe or if I am unable to comply with CDC and local health guidelines, or if I feel a family member is unsafe or unable to comply with CDC and local health guidelines, I have the choice to remove myself or my family member from the premises of APA.
- I agree, and my family agrees, to utilize surgical masks, or improvised masks such as scarves, bandanas, and handkerchiefs to reduce the risk of exposure to myself and others at school or any APA related activity or function.
- I agree, and my family members agree, to wash or sanitize our hands regularly, including after using the restroom, sneezing, and coughing, and to wear and utilize sterile gloves when requested.
- I agree, and my family members agree, not to enter the premises of APA if I or any family member is experiencing any of the following symptoms: nasal congestion, runny nose, sore throat, muscle aches, nausea, vomiting, diarrhea, loss of sense of taste or smell, fever (>100.4F), cough and/or shortness of breath.
- I agree not to enter the premises of APA if I reasonably believe I have COVID-19, or if I have likely been exposed to someone who has COVID-19. For purposes of this Consent, a person who has likely been exposed to COVID-19 is defined as any person who:
- is experiencing any of the symptoms listed above;
- has been directed to quarantine, isolate or self-monitor;
- has a known exposure to COVID-19; or
- resides with or has been in close contact with any person in the above-mentioned categories.
- I agree that if any member of my household has traveled internationally via commercial airlines within the preceding 14 days to a location identified by the CDC as a Level 2 or Level 3 risk area, any student(s) from my household may be removed from the school setting until medically cleared to return to school.
- I agree, and my family members agree, to observe and obey all posted rules, warnings and guidelines, and further agree to follow any verbal instructions or directions given by APA representatives to mitigate my potential exposure to COVID-19.
- I agree, and my family members agree, that although APA and I are taking steps to reduce the risk of COVID-19 exposure, we cannot eliminate the risk, especially for higher risk students, participants and attendees.
- I agree, and my family members agree, that participation/attendance at on-campus classes or other school related activities and functions may be hazardous to my health and the health of my family, and agree that I assume all such risk of COVID-19 exposure on my behalf and on behalf of my family.
- I agree, and my family members agree, to abide by and follow attendance recommendations, decisions, and instructions by APA and/or APA’s Medical Advisory Committee concerning COVID-19.
- I agree that by signing below, I and my family members will comply with the written instructions above, and that failure to comply with any written instructions or any verbal instructions from APA and/or Associates while attending or participating in on-campus classes or any other school related activities and functions may result in my removal, or my family member’s removal, from the premises.
- I agree that by signing this Consent, I hereby release APA and Associates from all liability for claims, foreseeable and unforeseeable, arising from exposure to COVID-19, and any harm, injuries or damages I may, or my family may experience our participation/attendance in on-campus classes or other school related activities and functions.
- I agree that by signing this release, I intend to bind my spouse, next-of-kin, heirs, insurers, legal representatives, assigns, successors and anyone else claiming harm, injury or damage resulting from my exposure, or any family member’s exposure, to COVID-19. Therefore, this release applies to my spouse, child(ren), next-of-kin, heirs, ward(s), legal representatives, insurers, assigns and successors, as well as me.
- I agree that I am aware of the legal consequences of this consent form, including that it prevents me from suing APA and Associates for any reason related to COVID-19 and my, or my family member’s, participation/attendance in on-campus classes or other school related activities and functions.
- I agree that in no event shall APA and Associates by liable for compensatory, punitive, incidental, consequential (including lost profits), special, or exemplary damages resulting from my exposure to COVID-19 in connection with my attendance or participation, or my family’s attendance or participation in on-campus classes or other school related activities and functions.
- I acknowledge that I am under no pressure or duress to sign this COVID-19 Consent: Waiver and Release.
- I agree that this COVID-19 Consent: Waiver and Release is intended to be as broad and inclusive as permitted by North Carolina law and that it shall be governed and interpreted by North Carolina law; and further, I agree that if any portion of this consent form is held invalid, the balance shall continue in full force and effect.
Signature for Consent to Attend/Participate
You must complete this form for each student that will be attending Parrott Academy in August.
The first part of this consent form told you about COVID-related risks. If, after reviewing this form, you do not believe that you reasonably understand the risks and choices, do not sign the form until you have your questions answered and fully understand such risks and choices.