Growing IQ COVID-19 Screening & Waiver Form

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Please complete this form before entering our center to ensure a safe and healthy environment for all children and staff. Also, note that if the form is not received before your child's class, we reserve the right to refrain students from attending classes.

We greatly appreciate your understanding and cooperation.

Email *

Today's Date *

YYYY

Parent Name *

Mobile Number *

Child(ren) Name *

Does your child or any family member have / had any of the following symptoms in the last 14 days? *

Yes

Fever

Chills

Fatigue

Muscle or body aches

Headache

New loss of taste or smell

Sore throat

Congestion or runny nose

Nausea or vomiting

Diarrhea

Within the past 14 days: *

Yes

Has your child travelled / visited area/neighborhoods outside of US with documented COVID-19 transmission?

Has your child come in contact with a person with confirmed COVID-19 infection?

Has your child tested positive for COVID-19 or had COVID-19?

I the parent/guardian, understand that DSHS Texas and CDC recommends these actions to help prevent the spread of any respiratory virus, including COVID‑19 and I agree that my child will follow the same while participating in Growing IQ program while at the center: *

I agree

Wash hands before and after class.

Wear a mask to cover the face while at the center.

Stay social distanced from others.

Medical Release Information: In consideration of my child participating in Growing IQ program, I waive all claims against the Growing IQ, affiliates, employees, trustees, and agents, individually and in their capacity as such for injury or illness, including COVID-19, which may directly or indirectly result from participation in the program. I accept all risk of my child contracting COVID-19 associated with my child's participation in the program and waive any and all claims against the above persons or entities related to contracting COVID-19. My claims remain waived even though liability may arise out of negligence or carelessness of persons or entities mentioned above. I understand that the program will be held in accordance with applicable local, state, and federal guidance related to the COVID-19 pandemic. I understand that the Growing IQ has adopted specific guidelines for in-person sessions and that I and my child must abide by all guidelines enacted by Growing IQ including those related to limiting the spread of COVID-19. I understand that my child will not be allowed with the campus unless the above agreement is accepted by a legal parent or guardian and I agree to abide by all Growing IQ policies and procedures. *

I, the parent/legal guardian, read and agree entirely to the Medical Release Information.

Growing IQ Terms Of Service: www.txgrowingiq.com/termsofservice *

I, the parent/legal guardian, read and agree entirely to the Growing IQ Terms Of Service.

Send me a copy of my responses.

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