COVID-19 Consent Form (All fields must be filled properly) - All Pass Driving School LTD. Stouffville/Markham

Student Driver Name*

First Last

Parent/ Guardian Full Name & Cell phone number

Student Email address.

Driving lesson Date ( Only date required )*

Parent / Guardian Email address*

Enter Email Confirm Email

Payer can be Parent/Guardian or the person paying for this course

Address*

Full Address City Postal Code

Driving lesson Start & Finish Time*

You must have a confirmation text from your driving Instructor when booking driving lessons (This is required in case of dispute)

Have you been vaccinated for Covid-19 if yes when?*

Please confirm your vaccination ,if you received both doses please write fully vaccinated if only one dose Please write first dose only

Student Cell Phone*

Your Driving Instructor's Name ?*

Please write Driving Instructor first name

I / Parent /Guardian ( if applicable )confirm the following statements to be true. Yes/No*

Yes
No

COVID-19 Private In-Car Lessons Liability Waiver . Please read all the following Declaration & Agreement, Your submission indicates that you understand the agreement and wish to proceed with a scheduled private In-Car lessons ANY FALSE STATEMENTS MAY LEAD TO LEGAL ACTIONS AGAINST STUDENT DRIVER/APPLICANT AND OR PARENT/GUARDIAN (IF APPLICANT UNDER 18 YEARS OF AGE)

Do you (The student driver ) experience any of these symptoms fever, cough, difficulty breathing, muscle aches, fatigue, headache, sore throat , runny nose, conjunctivitis, loss of taste or smell,rash on skin ,chest pain or pressure,loss of speech or movement & diarrhea ?*

Yes
No

Please read everything carefully before selecting YES OR NO

1.Have you (the student driver) travelled outside of Canada in the last 14 days? 2.Did you come to contact with someone who has tested positive for COVID-19 ? (for example, in your household No workplace?) 3.Are you in close contact with someone who has traveled outside of Canada in the last 14 days or is in self-isolation? In the last 14 days have you been flying on planes or used public transportation such as Train ,or Buses?*

Yes
No

Declaration*

I Fully understand and agree to All Pass's Declaration

I hereby agree to bring and wear my own face mask ,gloves and bring my own hand sanitizer during all driving lessons, Instructors may also use thermometer to make sure your body's temperature is normal. All Pass Driving School Instructors will maintain social distancing and Ontario Guidelines of Health.

Disclaimer*

I fully understand and agree to All Pass's Disclaimer

All Pass Driving School LTD. and its employees, officers and Driving Instructors will take every known precaution possible to prevent the spread of the Coronavirus (COVID-19), however, there are certain inherent risks of participating in the in-car lessons which are totally outside of the control of our Driving instructors. If any of the above questions are answered with a “YES”, YOU WILL NOT BE ALLOWED TO BOOK DRIVING LESSONS FOR AT LEAST 3 WEEKS .

Consent*

I fully understand and agree to All Pass's Consent & All terms and Conditions

I hereby indemnify, remise, release, discharge, acquit and forgive All Pass Driving School LTD. and their employees and contractors from all actions, causes of actions, suits, duties, demands claims, costs and expenses of any kind related to any health risks or adverse health related consequences, arising as a result of in-car lessons.

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COVID-19 Consent Form must be filled 24 hours prior meeting your Instructor