I acknowledge that federal and state government officials have declared that there currently exists a public health crisis in our country related to the Coronavirus Disease 2019 ("COVID 19").
I confirm that I will not permit my child to participate in Grace Childcare if, at any time during the program or activity, my child is showing any symptoms of COVID-19 (including but not limited to fever, dry cough, fatigue, shortness of breath, chills, muscle pains). Additionally, I confirm that I will not permit my child to participate in Grace Childcare if, at any time during the program or activity, my child has been in contact with any individual diagnosed with COVID-19 or any individual currently waiting for test results confirming the possibility of a COVID-19 diagnosis. I agree that in such situations my child will be unable to participate in Grace Childcare until: (i) 14 calendar days after the symptoms first appeared and my child is no longer showing any symptoms; or (ii) a healthcare provider has confirmed in writing that my child has tested negative for COVID-19 or that my child's symptoms were not due to COVID-19.
I understand that Grace Childcare cannot prevent the possible transmission or contraction of COVID-19 for my child.
The undersigned agrees to release, discharge, hold harmless and indemnify Grace Church Saint Louis, its agents, employees, volunteers, and others acting on the church's behalf (the "Releasees"), of and from any and all claims, demands, causes of action and/or legal liabilities for injuries to or death of my child occurring during, resulting from, or participation in the above mentioned program or activity and related in any way to COVID-19, even if the cause, damages or injuries are alleged to be the fault of or alleged to be caused by the negligence or carelessness of the Releasees.
*What is the age of your child today?
*What grade is your child this school year?
*Does this child have any allergies or special needs?
*What day of the week is your class or event?
We ask that you pay with cash upon arrival.
By signing below, I give permission for my child/ward, named above, to participate in Grace Childcare at Grace Church Saint Louis.