Safe Start Driving School

                                                      DISEASES INCLUDING COVID-19

(Please Print)
Student Legal Name: ____________________________________________________________________________
Home Phone: __________________________________CellPhone_______________________________________

Address: _____________________________________________________________________________________

Parent(s)/Guardian(s) Names: ____________________________________________________________________

Parent(s)/Guardian(s) Names: ____________________________________________________________________

Parent/ Guardian phone: Cell: ________________________________Home: _______________________________

The novel coronavirus (“COVID-19”), has been declared a worldwide pandemic by the World Health Organization.
COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. While rules,
guidance, and personal discipline may reduce this risk, the risk of serious illness and death does exist.  The School
Safe Start Driving School cannot completely mitigate the transfer of communicable diseases like COVID-19 especially
when involved in driving school activities  Participation includes possible exposure to and illness, injury, or death from
infectious diseases including COVID-19.

In consideration for providing my child the opportunity to participate in drivers ed, classroom and behind the wheel
instruction, both my child and I voluntarily agree to waive and discharge any and all claims against Safe Start Driving
School and release it from liability for any exposure to or illness or injury from an infectious disease including COVID-
19, including claims for any negligent actions of the school or its employees or agents, to the fullest extent allowed by
law, for myself, my child, our estates, our heirs, our administrators, our executors, our assignees, and our successors.  

I also agree to release, exonerate, discharge and hold harmless the school, the individuals thereof, and all officers,
agents, employees, volunteers, and representatives from all liability, claims, causes of action, or demands, including
attorney fees, fines, fees, or other costs (e.g. medical costs) arising out of any exposure to or illness or injury from an
infectious disease including COVID-19, which may result from or in connection with my child’s participation in drivers ed

I further certify and represent that I have the legal authority to waive, discharge, release, and hold harmless the released
parties on behalf of myself and the above-named student.

I certify that I have read this document in its entirety and fully understand its contents.  In exchange for the opportunity to
participate in drivers ed for the above-named student, and I freely and voluntarily assume all risks of such hazards and
notwithstanding such, release Safe Start Driving School from all liability for any loss regardless of cause, and claims
arising from the student's participation.    

Student Signature                                                                                                                              Date

Parent/Legal Guardian Signature                                                                                                    Date