This agreement supplements the general informed consent/business agreement that we agreed to at the start of our work together.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child and I may be exposed to or infected by COVID-19 by engaging in services with Dr. Heidi Cherwony 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 at the office of Dr. Heidi Cherwony may result from the actions, omissions, or negligence of me and others, including, but not limited to building staff, other professionals in the building and their clients. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any illness my child or I may incur in connection with services provided.
On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Dr. Heidi Cherwony any claims, including all liabilities, actions, damages, costs or expenses of any kind arising out of or relating to COVID-19. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Dr. Heidi Cherwony, whether a COVID-19 infection occurs before, during, or after services provided.