Dear Parents/Visitors,

Please review the stipulations below and print/type and date your name below as an acknowledgment of your understanding and agreement to the terms before arriving at our office for your appointment. Thank you!

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I acknowledge the contagious nature of COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.

I further acknowledge that Veritas Education has put in place preventative measures to reduce the spread of COVID-19.

I further acknowledge that Veritas Education cannot guarantee that I/my child will not become infected with the COVID-19. I understand that the risk of becoming exposed to and/or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Veritas staff, other clients, and their families.

I voluntarily seek services provided by Veritas Education and acknowledge that I am increasing my/my child's risk to exposure to COVID-19. I acknowledge that I/my child must comply with all set procedures to reduce the spread while attending my appointment.

I attest that:
* I am/my child is 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 (my child has) not traveled internationally within the last 14 days.
* I have (my child has) not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I have (my child has) been exposed to someone with a suspected and/or confirmed case of COVID-19.
* I have (my child has) not been diagnosed with COVID-19 and not yet cleared as non contagious by state or local public health authorities.
* I am/my child is following all CDC recommended guidelines as much as possible and limiting my/my child's exposure to COVID-19.

I hereby release and agree to hold Veritas Education 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 company, or that may otherwise arise in any way in connection with any services received from Veritas Education. I understand that this release discharges Veritas Education from any liability or claim that I, my heirs, or any personal representatives may have against the company 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 Veritas Education. This liability waiver and release extends to the company together with all owners, partners, and employees.