COVID-19 Liability Waiver

Client's Full Name

Legal Guardian's Name (if applicable)

I have read the Covid-19 Liability Waiver as stated below and I understand the material. I further understand that by checking this box, I sign this release and voluntarily surrender certain legal rights, such as I may be required to wear a mask during treatment if my provider requests as such.

Legal Guardian Signature

Date

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COVID-19 LIABILITY WAIVER

READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS

In exchange for use of the property, facilities, and services of Sunshine Pediatric Therapy, LLC, of the greater Atlanta, Georgia area, agree for myself and (if applicable) for the members of my family, to the following:

1. AGREEMENT TO FOLLOW DIRECTIONS. I agree to observe and obey all posted rules and warnings regarding COVID-19, and further agree to follow any oral instructions or directions given by Sunshine Pediatric Therapy, LLC, or the employees, representatives or agents of Sunshine Pediatric Therapy, LLC.

2. ASSUMPTION OF THE RISKS AND RELEASE. I recognize that there are certain inherent risks associated with the above described activity regarding COVID-19, acknowledge the contagious nature of COVID-19 and understand that CDC and public health authorities recommend the practice of social distancing, and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge Sunshine Pediatric Therapy, LLC for injury, loss or damage arising out of my or my family's use of or presence during therapy services as rendered by Sunshine Pediatric Therapy, LLC, whether caused by the fault of myself, my family, Sunshine Pediatric Therapy, LLC or other third parties.

I acknowledge that Sunshine Pediatric Therapy, LLC has followed all local and state requirements regarding the coronavirus pandemic to reduce the spread of COVID-19. I acknowledge that Sunshine Pediatric Therapy, LLC cannot guarantee that I will not become infected with COVID- 19.

3. INDEMNIFICATION. I agree to indemnify and defend Sunshine Pediatric Therapy, LLC against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the services and providers of Sunshine Pediatric Therapy, LLC.

4. APPLICABLE LAW. Any legal or equitable claim that may arise from participation in the above shall be resolved under Georgia law.

5. NO DURESS. I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire.

6. ARM'S LENGTH AGREEMENT. This Agreement and each of its terms are the product of an arm's length negotiation between the Parties unless the provider is granted consent to work with the client. The client has right to request the service provider to wear a mask. In the event any ambiguity is found to exist in the interpretation of this Agreement, or any of its provisions, the Parties, and each of them, explicitly reject the application of any legal or equitable rule of interpretation which would lead to a construction either "for" or "against" a particular party based upon their status as the drafter of a specific term, language, or provision giving rise to such ambiguity.

7. ENFORCEABILITY. The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement..