Covid-19 – OnlineMusicLesson.com

Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), our businesses are taking extra precautions with the intake of every students, teachers and staff members to include health history review as well as sanitation and disinfecting practices.
If you ever need to visit one of our partnered Musipire Music School facilities in New York City, Please complete the following and sign below.

Date

First Name

Last Name

Do you have any children that are currently enrolled active students of Musipire Music School?

Yes

How many of your children will be visiting our affiliated Musipire facilities in NYC?

Child First Name

Child Last Name

Child First Name

Child Last Name

Child First Name

Child Last Name

Child First Name

Child Last Name

Child First Name

Child Last Name

Symptoms of COVID-19 include:

Fever
Fatigue
Dry cough
Difficulty breathing

I, agree the following

I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.
I affirm that I, as well as all household members, have not been diagnosed with COVID19 within the last 30 days.
I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.
I affirm that I, as well as all household members, have not traveled outside of the country, or to any city outside of New York City that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days.
I understand that Online Music Lesson.com and Musipire Inc. cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client

By signing below I agree to each above statement and release Online Music Lesson.com and Musipire Inc. from any and all liability for the unintentional exposure or harm due to COVID-19.

Online Music Lesson.com and Musipire Inc. and all of the employees and contractors of its operating facilities agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable condition.

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