Precautionary Liability & Intake Form
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COVID-19 RELEASE OF LIABILITY & PROCEDURES
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health
Organization. COVID-19 is 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 limited the number of group gatherings.
PROCEDURES FOR ATTENDING ANY IN-PERSON SESSIONS WITH CHE'DRA
I understand that to participate in classes, appointments, and events with Che'dra Joseph, @CHEDRATIPS that I may be subject to the following to be allowed in-person sessions: My temperature being taken; Social distancing; Wearing a facial covering to protect yourself and others; Proper hand washing hygiene and use of hand sanitizer as needed; Covering of coughing and or sneezing; Not being of ill health or currently sick; Being asked to leave if I have a fever or show symptoms of COVID-19;  Adhering to state mandate if deemed high risk by state, federal and CDC guidelines *
Required
RELEASE OF LIABILITY
I understand that the risk that I may become exposed to or infected by COVID-19 is my sole responsibility and CHE'DRA waives all liability as aforementioned best practices will be followed. I release all liability from CHE'DRA from the actions, omissions, or negligence of myself and others, including, but not limited to, CHE'DRA and its' employees, volunteers, and participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at the studio or participation with CHE'DRA(s) events and services. *
Required
I hereby release liability and hold harmless CHE'DRA, its employees, agents, and representatives from 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 CHE'DRA, its employees, agents, participants, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any CHE'DRA activity or attendance of a class or appointment. Initial below. *
I understand my responsibility in staying home when ill, informing CHE'DRA of an expected or confirmed case of COVID-19 exposure, maintaining proper hygiene, and following the proper social distancing procedures when participating or attending CHE'DRA classes and services. *
Required
LIABILITY WAIVER AND INTAKE FOR CHILDREN, TEENS & ADULTS
I hereby agree to the following: I and/or my child has permission to attend or participate in an event, appointment, class or session from Che'dra Joseph, @CHEDRATIPS. I and/or my child are participating in classes or services during which we will receive information and instruction including but not limited to reiki, health, art, graphic design, branding, mindfulness and meditation. I recognize that IF I participate in yoga it requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my and/or my child’s participation in any physical fitness program, including yoga. I represent and warrant that I and/or my child have no medical condition that would prevent us from participation in physical fitness activities and it is my responsibility to make CHE'DRA aware of any prior injuries or health concerns that could be affected by class. In consideration of being permitted to participate in yoga classes and reiki remedies and any other in-person group or one-on-one sessions, I agree to assume full responsibility for any risks, injuries or damages, known and unknown, which I and/or my child might incur as a result of participating in the program. In further consideration of being permitted to participate with CHE'DRA, I knowingly, voluntarily, and expressly waive any claim I and/or my child may have against the instructor, the owner, or the leaseholder of the building for injuries or damages that I and/or my child may sustain as a result of participating in classes or workshops conducted by Che'dra Joseph, @CHEDRATIPS. Please Initial. *
MEDICAL
I understand that all information and guidance received by CHE'DRA, is for the purpose of self health and wellness and is to not take the place of medical professionals. I understand that CHE'DRA is acting as a practitioner of information and a conduit of self-accountability. All content found on the Guruche.com and provided by CHE'DRA, including: text, images, audio, or other formats were created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website or received from CHE'DRA. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. CHE'DRA does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on verbally or virtually. Reliance on any information provided by CHE'DRA, it's employees, and participants is solely at your own risk. The website may contain health- or medical-related materials or discussions. If you find these materials offensive, you may not want to use our Site. The Site and its Content are provided on an "as is" basis. Links to external content not created by CHE'DRA and are taken at your own risk. CHE'DRA is not responsible for the claims of external websites and education companies. *
Required
PHOTO RELEASE
I give my permission for Che'dra Joseph, @CHEDRATIPS to use my or my child’s image (photo or video) for website or newsletter and teaching seminars. I and/or my child will not be identified by name in such images unless otherwise approved by client. *
Date *
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DD
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YYYY
Gender and pronouns
Email Address *
Emergency Contact: Please include name, relationship and contact number. *
Name or name of minor, if applicable; and relationship to minor
Minor's types signature, and notice of consent; Please have your child type his/her own name, with the following statement: I ________________ want and consent to participate with CHE'DRA.
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