I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing and the wearing of masks/facial coverings whether or not you are vaccinated.

I further acknowledge that Grass Valley Kenpo Family Karate (which will be referred to as GVKFK for the remainder of this document) has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that GVKFK cannot guarantee that I will not become infected with the Coronavirus/COVID-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff members, other clients, participants, students, and their families.

I voluntarily seek services provided by GVKFK and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all GVKFK’s set procedures to reduce the spread while attending my lesson and/or class, including wearing a mask.
I attest that:

• I am 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 do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
• I have not been diagnosed with Coronavirus/COVID-19 and not yet cleared as non-contagious by state or local public health authorities.
• I understand I have a duty to inform my instructor, and will not attend any classes or enter the building at GVKFK for 14 days if I develop any of the above Coronavirus/COVID-19 related symptoms, I become aware of being in contact with someone who has subsequently tested positive for Coronavirus/COVID-19 within the last 14 days, and/or I test positive for Coronavirus/COVID-19 myself.
• I agree that I will take my temperature before arriving at GVKFK each day and it must be less than 100.4° F.

I hereby release and agree to hold GVKFK 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 GVKFK, or that may otherwise arise in any way GVKFK from any liability or claim that I, my heirs, or any personal representatives may have against GVKFK 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 GVKFK. This liability waiver and release extends to the dojo together with all owners, partners, employees, agents, representative, affiliated organizations, students and clients.