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Liability release, Informed consent, Covid-19 questionnaire

Liability release

Liability release

I, the undersigned, am employing ASPIRE for the purpose of instruction. In  consideration for this instruction I hereby release ASPIRE and its agents and  employees, and agree to hold them harmless from any and all liability,  claims, damages, actions and cause of action whatsoever, for loss,  damages or injury to person or property, irrespective of how arising and  however caused, including but not limited to all kinds and degrees or  extent of negligence with which ASPIRE, its agents or employees may be  charged in connection, directly or indirectly with those volunteering to be  a demonstration patient.   I further agree to disclose in writing below, all of my physical and medical  conditions, limitations and sensitivities, and agree to release and hold  ASPIRE, its agents and employees harmless from any liability, claims,  damages, actions and causes of action in any way relating to or arising  from said conditions, limitations or sensitivities.   I further agree that ASPIRE, its agents and employees shall not be liable for  any claims, demands, injuries, damages, actions or causes of action  whatsoever arising out of, or connected with the use of any of its services,  facilities or equipment. I hereby expressly forever release and discharge  ASPIRE, its agents and employees from all such claims, demands, injuries,  damages, actions or causes of action, and from all acts of active or  passive negligence on the part of ASPIRE, its agents and employees. 

Informed consent

I consent to the taking of photographs, motion pictures, videotapes and to the  preparations of other graphic materials, including various social media, where  appropriate by Andrews University, Department of Physical Therapy, and  ASPIRE OMT for the purpose of class instruction and demonstration.
While participating in this activity, I agree that the department may use or permit other  persons to use these prepared negatives or prints. I realize that this documentation may  be used in the future for presentations or in scientific or medical publications and  reports.

Covid 19 questionnaire

Self-Declaration In the last 14 days, have you received a confirmed diagnosis for coronavirus (COVID-19) by a coronavirus (COVID-19) test or from a diagnosis by a healthcare professional or are you waiting for a pending COVID-19 test result?
In the last 14 days you have traveled internationally?
In the last 14 days, have you had close contact with or cared for someone diagnosed with COVID-19 or are you participating in a COVID-19 clinical study that includes being exposed to the virus?
In the last 14 days, have you experienced any cold or flu-like symptoms (to include fever, cough, shortness of breath or difficulty breathing, sore throat, pressure in the chest, extreme fatigue, earache, persistent headache, diarrhea, vomiting, muscle pain, chills, repeated shaking with chills, and persistent loss of smell or taste)?

Thanks for submitting!

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