Name *

First Name

Last Name

STUDENT NAME (1)

First Name

Last Name

STUDENT NAME (2)

First Name

Last Name

PARENT or LEGAL GUARDIAN

First Name

Last Name

As with the transmission of any communicable disease like a cold or the flu, you and/or your child may be exposed to COVID-19, also known as “Coronavirus,” at any time or in any place. Rest assured we will be following all public health guidelines for day care centers and camps, and taking extra precautions whenever possible. Despite our careful attention to cleaning, disinfection, and use of personal barriers, there is still a chance that you and/or your child could be exposed to an illness at Vita Art Center. Although we have taken measures to provide social distancing at Vita Art Center, due to the nature of working with children, it is not possible to maintain social distancing at all times. Although exposure is unlikely, do you accept the risk and consent to attending classes at Vita Art Center?

YES

NO