Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

Fill out the form below to participate in events at Delaney Baptist Church

Parent/Guardian Information

First Name

Last Name

Date of Birth

YYYY

Phone Number

(###)

###

####

Email Address:

Minor 1 Information

First Name

Last Name

Date of Birth

YYYY

I acknowledge that I will be participating as a volunteer or participant in activities at The Delaney Street Baptist Church of Orlando, Florida, Inc. (“Delaney”).

The 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. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

I Understand

Delaney has put in place preventative measures to reduce the spread of COVID-19. However, attending activities on Delaney’s campus could increase the risk of contracting COVID-19, and Delaney cannot guarantee that you [or your child(ren)] will not become infected with COVID-19.

I Understand

Upon arrival at the Delaney campus, I agree to use the restroom to wash my hands prior to participating in any activity. Hand sanitizer for your use is also conveniently located throughout the Delaney campus. Further, a dis- posable mask will be provided to you. (You are more than welcome to provide your own face covering.)

I Agree

By submitting this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I [or my child(ren)] may be exposed to or infected by COVID-19 by attending activities on Delaney’s cam- pus, and that such exposure or infection may result in personal injury, illness, disability, and death. I further understand that the risk of becoming exposed to or infected by COVID-19 at Delaney may result from my ac- tions or omissions, or those of others, including, but not limited to, Delaney employees, volunteers, and program participants.

I Agree

I acknowledge and agree to fully assume the risk of illness or death related to COVID-19 arising from my being on Delaney’s campus and participating in activities on the Delaney campus, and agree to release Delaney, its em- ployees, volunteers, and program participants from any and all liability for unintentional exposure or harm due to COVID-19.

I Agree

FOR PARTICIPANTS UNDER AGE 18 AT THE TIME OF PARTICIPATION

This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/ her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all lia- bilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.

I Agree

By submitting this form, you confirm that you have read and are agreeing to the Terms and Conditions of the Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 form.