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Please submit this form online prior to your return to Spokane Aerial classes or prior to your first class.  Please save and print this form after completed.  Also, please review each question from this form each week before coming to each class, on the day of your child's class or your own class.  This COVID-19 waiver is required of all students of Spokane Aerial Performance Arts LLC.  Please feel free to call or email us at 509-435-1576 or spokaneaerial@comcast.net, if you have any questions.  The link to this Weekly COVID-19 form can be found at the bottom of each page of our website. 

Thank you in advance for reviewing this on a weekly basis before coming to class.

Please select the student(s) that will be participating at Spokane Aerial.
AdultMinor
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First Student(s) and/or Family Name

First Name*

Last Name*

Phone*
First Student(s) and/or Family Date of Birth*
I certify that I am 18 years of age or older
First Student(s) and/or Family Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Please read each question carefully and check the boxes that apply.

If you have 2 minor children in a class at Spokane Aerial, please enter their names here. You are only required to complete one form per family. For ADULT students, please disregard this question.
Do you, your minor student(s) or any family member have any of the following symptoms? Please check any/all boxes that apply.
Cough
Fever
New loss of taste or smell
Do you, your minor student(s) and/or any family members have at least 2 of the following symptoms? If so, please check 2 or more of the boxes below that apply.
Repeated shaking with chills
Headache
Diarrhea
Chills
Muscle Pain
Sore Throat
Vomiting
Shortness of breath
Have you, your minor student(s) and/or family members recently had close contact a person with a positive COVID-19 test? A close contact is any person who was within 6 feet of a contagious COVID-19 case for at least 15 minutes. A person is contagious 2 days before their illness onset (or, for asymptomatic patients, 2 days before positive test was collected) until the time they are isolated. *
Yes
No

If you checked YES to the question above, or checked any boxes, please do not come to class or bring your minor student to class.

Please call to arrange a make-up once you or your minor student has been quarantined according to the Spokane County Health District or has not shown symptoms according to the Spokane County Health District recommendations, OR has tested negative for COVID-19.

If you or your minor student has attended a class and tests positive at any time please notify us as soon as possible so we can notify all students within the class.

For your reference the following is the COVID-19 homepage on the website of the Spokane County Health District. https://covid.srhd.org/

If you checked NO to the question above and did not check any boxes, please come in for the class or bring your minor student in for the class. 

Prior to each class:  Be sure to wash or sanitize your hands before you or your minor student enters the facility or immediately upon entering the facility. If you need to use the bathroom at our facility prior to class to wash your hands, feel free to do so.  Please remember to remove your shoes and use the bathroom near the Jujitsu floor (west side of building).

Non-students entering the facility are limited to one per minor student. For example, one parent may accompany the minor student(s).  Please do not bring additional family members.  

If entering the building and waiting for your minor child(ren), always remember to enter the facility with your mask on, sit at a socially distanced space at all times, and leave your mask on the entire time.  

By signing I understand that it is my responsibility to do this check on myself or my minor student for all symptoms prior to coming to each and every class. *
I agree
I do not agree.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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