Visitor Form

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Thank you for coming by! Please fill out the form below prior to visiting our campus.

Name

First Name

Last Name

Parent/Guardian Name

Required if visitor is a minor (under 18 years old).

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What is the nature of your visit to OC Music & Dance?

Date of visit to OC Music & Dance

YYYY

How did you hear about OC Music & Dance?

Please add my e-mail to your contact list

Waivers

CORONAVIRUS WARNING AND COMMITMENT: I understand that there is widespread and ongoing transmission of the novel coronavirus (“COVID-19”) worldwide, including throughout Orange County, California. I am informed that, as of June 1, 2020, the Center for Disease Control (CDC) and the State of California have identified key symptoms of this disease, including: • Fever (body temperature of 100.4 degrees Fahrenheit or greater) • Cough • Shortness of breath or difficulty breathing • Chills • Muscle pain • Headache • Sore throat • Nausea or vomiting • Diarrhea • New loss of taste or smell. I also realize that I or my child may be at risk if I or my child or other member of my family has traveled abroad or been in close contact with someone who has traveled abroad. I commit that neither myself, my child, or other members of my family, shall visit or utilize the facilities, services, and programs of OCMD (other than any exclusively online services and programs) if any one of us: (i) experiences symptoms of COVID-19, including those stated above, or (ii) has a suspected or diagnosed/confirmed case of COVID-19, or comes in close contact with someone who has recently traveled abroad or presented any of these symptoms within 14 days of my or my family coming to OCMD. I agree to notify OCMD immediately if a member of my family believes that any of the above restrictions may apply. I have been informed that OCMD has developed a set of Health and Safety Policies, intended to protect myself and my family, as well as all OCMD students and their families, teachers, and staff. Among these policies are requirements that: Everyone entering OCMD’s building may be required to undergo screening, which includes allowing OCMD to take my or my child’s temperature, using a non-contact digital thermometer, and asking questions regarding the above Covid-19 symptoms and information about traveling abroad. OCMD reserves the right to deny entry if anyone has a fever or presents two or more of the above symptoms. Anyone over the age of two-years will be required to wear a facial covering. Everyone in the building will be asked to maintain physical distancing where possible; and I commit to honor these requirements, as they may be implemented or modified from time to time. PHOTO AND VIDEO RELEASE: I agree to the photo and video release found at https://ocmusicdance.org/policiesandwaivers LIABILITY WAIVER: I understand that my (or my minor child's) participation could include actions or tasks which might be hazardous to myself (or child), including the impact of the coronavirus. In addition, I accept that, notwithstanding OCMD’s Health and Safety Policies, there are still risks that these efforts might not prevent myself, my child, or other members of my family, from contracting the disease. By accepting below, I assume any and all risks of harm or injury which may occur to me (or my child) during my (or my child's) participation, except for reasons of gross negligence or neglect by OCMD. I, for myself (or on behalf of my child) release and agree to hold harmless OCMD, its teachers, staff, volunteers, and artistic partners, as well as other participants, from all such liability and costs incurred to recover damages during such participation in class or during events and activities, whether on-site at OCMD or off-site on behalf of OCMD. MEDICAL WAIVER: In the event of injury or illness during my or my child’s participation at OCMD, I hereby authorize OCMD to consent to medical treatment on my or my child’s behalf as deemed necessary on the advice of trained emergency personnel. I agree that it is my responsibility to obtain and maintain health insurance coverage for myself or my child prior to any participation with OCMD and that I am responsible for any medical expenses arising out of any injury to claim to occur during participation.

I agree to the terms stated above

I agree

Visitors Electronic Signature

Type your name below to agree

Visitor Form

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