DISCLAIMER: Due to parent disclosing current work situation and utilizing appropriate social distancing measures. We are aware and are making an exception to this informed consent provided the client and technician continue to be symptom free.

This document outlines the requirements to remain eligible for services from EAS during the COVID-19 pandemic and outlines the potential risks to continuing services.

In the interest of staff and client safety, it is our expectation that you: • Provide EAS Staff with regular accurate information about the status of being exposed to someone with COVID-19 symptoms (fever, cough, shortness of breath).
• Provide EAS staff with daily accurate information about the status of all members of the household in regards to showing any signs of COVID-19 as outlined by the state and local government (fever, cough, shortness of breath).
• Take a daily temperature of everyone in the household and immediately notify EAS staff if someone has a temperature of 100.4 or higher In addition, we ask that you agree to the following in line with state and local government guidelines:
• All members of the household will refrain from public gatherings (anyone that still has to work should remain isolated from staff while rendering services in the home) and will refrain from having visitors to the home
• All members of the household agree to wash hands frequently, to include after sneezing, coughing, blowing nose, touching face, or consuming food or drink.
• If services are being rendered in the home, the space in which the client and clinician will be using must be thoroughly sanitized with disinfectants before and after each session, to include the restroom that the technician will be using. • All members of the household agree to use social distancing while interacting while interacting with staff in the home.
• Staff will not bring toys and materials into the home.

Our staff has been made aware of all state and local social distancing requirements and we will continually keep them up to date on their obligations. We take these orders seriously and have taken them into consideration when outlining these requirements. You will be immediately notified should the status of our staff change and potential exposure information will be shared with you, while maintaining required confidentiality. We will work to reduce the number of staff to only see one to two client maximum. Please be advised that if they become compromised, we will no longer be able to offer services.

These events render us unable to continue services • Not following any of the guidelines listed above
• Any member of the household coming into contact with a confirmed case of COVID-19
• Any member of the household showing signs of COVID-19 as outlined by the state and local government (fever, cough, shortness of breath)
• Any member of the household that has a fever or 100.4 or higher

We are agreeing to continue to provide services to your child within the home setting until events render us unable to. This agreement does not guarantee services and does not override any orders that may come from the state and local government. This agreement and the terms of this agreement may change at any time as this situation continues to evolve. In the event that we are no longer able to provide in person services, we will work with you to provide a suggested schedule, list of activities, strategies for teaching, and guidance on managing problem behavior. We will also work with you to setup video conferencing services to receive parent training services from our Board Certified Behavior Analyst.

By signing this agreement, you are acknowledging that you have read and understand the expectations for your child to continue receiving services from EAS. You acknowledge that you are not being forced into this agreement and are signing of your own free will. By signing this agreement, you also acknowledge that there is inherent risk in continuing to receive services either in the home or clinic setting while COVID-19 is still actively spreading. Even with all the precautions we are putting into place, we cannot guarantee that there will not be a transmission of COVID-19 between your household and our staff. By signing this agreement, you acknowledge that you will hold harmless, EAS and all associated personnel for all aforementioned companies, for any and all harm that may come from continuing services during the COVID-19 pandemic.