As a safety precaution for all users of PBT facilities, we require everyone to submit the below health screening prior to entering the building/campus each day.

  • COVID-19 Health Screening form

    As a safety precaution for all users of PBT facilities, we require everyone to submit this health screening prior to entering the building/campus each day.

    Please answer the following questions prior to your arrival at PBT. If you answer YES to any of the health screening questions, you must stay home. If you answer YES to any of the health screening questions, discontinue the survey and follow Allegheny County Health Department guidance (https://www.alleghenycounty.us/Health-Department/Resources/COVID-19/COVID-19.aspx) for next steps. Please also email the School inbox, PBTSchool@pittsburghballet.org, to notify that you were unable to pass the health screening. You needn't give specific details, just that you were unable to pass the health screening.
  • If you are completing this on behalf of your child/dependent, indicate your child/dependent's name, and complete the form based on your child/dependent's status.
  • If you are completing this on behalf of your child/dependent, indicate your child/dependent's level. If you are completing this form for the Community Division, please indicate "community".
  • If you are completing this on behalf of your child/dependent, indicate your email address.
  • Close physical contact is defined as being within 6 feet of an infected/symptomatic person for a cumulative total of 15 minutes or more over a 24-hour period starting from 48 hours before illness onset (or, for asymptomatic individuals, 48 hours prior to test specimen collection).
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  • If you completed this on behalf of your child/dependent, indicate your name.
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Additionally, we require consent to our updated Release of Liability and Assumption of Risk form.

  • RELEASE OF LIABILITY AND ASSUMPTION OF THE RISK – COVID 19

    1. I am aware of the highly contagious nature of COVID-19 and the risk that my child(ren) and I may be exposed to or contract COVID-19 while on the premises of and/or participating in classes at the Pittsburgh Ballet Theatre and Pittsburgh Ballet Theatre School (collectively, “PBT”). I understand and acknowledge that being on the premises of and/or participating in classes at PBT may increase my child(ren)’s and my risk of being exposed to or contracting COVID-19 and that PBT cannot prevent my child(ren) and me from being exposed to or contracting COVID-19.

    2. I agree that I am personally responsible for the safety of myself and my child(ren) while on the premises of and/or participating in classes at PBT. I agree that my child(ren) and I will comply with all PBT policies and rules, including but not limited to, all policies, guidelines, instructions, and posted signage. My child(ren) and I will not enter the premises of PBT or participate in classes at PBT if either myself, my child(ren), or any other members of our household are experiencing symptoms of COVID-19 (such as cough, shortness of breath, or fever), have a confirmed or suspected case of COVID-19, or have come in contact in the last 14 days with a person who has been confirmed or suspected of having COVID-19. I further agree to provide notice to PBT within 24 hours in the event myself, my child(ren), or any other member of our household tests positive for COVID-19.

  • 3. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 while on the premises of and/or participating in classes at PBT 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 may result from the actions, omissions, or negligence of myself, my child(ren), and others, including, but not limited to, PBT employees, volunteers, and others on the premises of and/or participating in classes at PBT. I, on behalf of myself and my child(ren), voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, arising from or related to my child(ren) or me being exposed to or infected by COVID-19 while on the premises of and/or participating in classes at PBT (“Claims”).

    4. On behalf of myself and my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless PBT and their owners, officers, directors, employees, agents, representatives, insurers, affiliates, successors and assigns (collectively, the “Releasees”) of and from the Claims, now know or hereinafter known, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of PBT and their employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after being on the premises and/or participating in classes at PBT. I promise, on behalf of myself and my child(ren), not to make or bring any Claims against PBT or any other Releasee and forever release and discharge PBT and all other Releasees from liability under such Claims.

    5. This waiver of liability and assumption of the risk agreement constitutes the sole and entire agreement of PBT and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This agreement is binding on and shall inure to the benefit of PBT and me and our respective successors and assigns. All matters arising out of or related to this waiver of liability and assumption of the risk agreement shall be governed by and construed in accordance with the laws of the Commonwealth of Pennsylvania, without giving effect to any choice of law provisions.

  • I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE OF LIABILITY AND ASSUMPTION OF THE RISK, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE THE RIGHTS CONCERNING LIABILITY AS DESCRIBED IN THIS RELEASE OF LIABILITY AND ASSUMPTION OF THE RISK.
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  • I am the parent or legal guardian of the minor child(ren) named below. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Release of Liability and Assumption of the Risk.
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