Student Health Screening

As a safety precaution for all users of Pacific Northwest Ballet facilities, we require everyone to submit this health screening prior to entering the buildings/studios each day.

Please answer the following questions, on behalf of your PNB student, no later than 90-minutes prior to your child’s arrival at PNB each day that your student is scheduled to attend in-person classes.  If you answer YES to any of the health screening questions, your child must stay home.  If you answer YES to any of the health screening questions, please complete the survey and then go to the King County Health Department COVID-19 Resources website for additional guidance.

We require consent to our Release of Liability and Assumption of Risk form below.

Release of Liability and Assumption of the Risk – COVID-19

1. I am aware of the highly contagious nature of COVID-19 and the risk that my child(ren) and I may be exposed to or contract COVID-19 while on the premises of and/or participating in classes at Pacific Northwest Ballet and Pacific Northwest Ballet School (collectively “PNB”). I understand and acknowledge that being on the premises of and/or participating in classes at PNB may increase my child(ren)’s and my risk of being exposed to or contracting COVID-19 and that PNB cannot prevent my child(ren) and me from being exposed to or contracting COVID-19.
2. I agree that I am personally responsible for the safety of myself and my child(ren) while on the premises of and/or participating in classes at PNB. I agree that my child(ren) and I will comply with all PNB policies and rules, including but not limited to, all policies, guidelines, instructions, and posted signage.  My child(ren) will not enter the premises of PNB or participate in classes at PNB if either myself, my child(ren) or any other members of our household are experiencing symptoms of COVID-19 (such as cough, shortness of breath, fever, loss of taste or smell), have a confirmed or suspected case of COVID-19, or have come in contact in the last 14 days with a person who has been confirmed or suspected of having COVID-19.  I further agree to provide notice to PNB within 2 hours in the event I, my child(ren), or any other member of our household tests positive for COVID-19.
3. By filling out the form below, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 while on the premises or and/or participating in classes at PNB and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself, my child(ren), and others, including, but not limited to, PNB employees, volunteers, and others on the premises of and/or participating in classes at PNB. I, on behalf of myself and my child(ren), voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, arising from or related to my child(ren) or me being exposed to or infected by COVID-19 while on the premises of and/or participating in classes at PNB (“Claims”).On behalf of myself and my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless PNB and their officers, directors, employees, agents, representatives, insurers, affiliates, successors and assigns (collectively, the “Releasees”) of and from the Claims, now known or hereinafter known, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree this release includes any Claims based on the actions, omissions, or negligence of PNB and their employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after being on the premises and/or participating in classes at PNB. I promise, on behalf of myself and my child(ren), not to make or bring any Claims against PNB or any other Releasee and forever release and discharge PNB and all other Releasees from liability under such Claims.
4. On behalf of myself and my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless PNB and their officers, directors, employees, agents, representatives, insurers, affiliates, successors and assigns (collectively, the “Releasees”) of and from the Claims, now known or hereinafter known, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree this release includes any Claims based on the actions, omissions, or negligence of PNB and their employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after being on the premises and/or participating in classes at PNB. I promise, on behalf of myself and my child(ren), not to make or bring any Claims against PNB or any other Releasee and forever release and discharge PNB and all other Releasees from liability under such Claims.
5. This waiver of liability and assumption of the risk agreement constitutes the sole and entire agreement of PNB and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This agreement is binding on and shall inure to the benefit of PNB and me and our respective successors and assigns. All matters arising out of or related to this waiver of liability and assumption of the risk agreement shall be governed by and construed in accordance with the laws of the State of Washington, without giving effect to any choice of law provisions.

BY FILLING OUT THE FORM BELOW, I AGREE THAT I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE OF LIABILITY AND ASSUMPTION OF THE RISK, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE THE RIGHTS CONCERNING LIABILITY AS DESCRIBED IN THIS RELEASE OF LIABILITY AND ASSUMPTION OF THE RISK.

I am the parent or legal guardian of the minor child named below. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Release of Liability and Assumption of the Risk.