Health and Permission Form
& Liability Waiver
With the recent challenges posed by COVID-19, the James River Association is asking participants to help us run programs as safely as possible. Please know that the risk of exposure to the COVID-19 virus cannot be completely eliminated. JRA asks each participant to fully evaluate your ability and willingness to participate in guidelines and understand the risks.
I understand and agree that I will not participate in this activity if I have experienced any of the following symptoms in the 14 days prior to this activity: new or worsening cough; shortness of breath or difficulty breathing; fever greater than 100.4ºF; chills; unexplained muscle pain, sore throat, new loss of taste or smell. I also agree that no one in my household has exhibited the above symptoms or that I have knowingly been in contact with anyone with confirmed COVID-19 in 14 days prior to this activity.
If the event Participant is under 18, the section below is to be completed by the Parent or Guardian. Please answer the following questions as fully as possible. A doctor visit or physical is not required.
All of the below information is to the best of my knowledge, correct. I understand that participation in the James River Association (JRA) activities is entirely voluntary. I understand that the JRA event may involve “hands on” activities such as planting trees, using equipment, boating or wading in shallow water; and I understand the risks and dangers involved in the above-named activities. I know and understand that unanticipated dangers might arise. I hereby release JRA from any responsibility for injury which might occur as a result of participation in JRA activities. I give permission to authorize personnel to carry out such emergency diagnostic and therapeutic procedures as may be necessary for me/my child, and also permit such treatment procedures to be carried out at and by the local hospital(s) for me/ my child in the event of an emergency. I understand that any medical expenses will be billed directly to me or my insurance company. I hereby grant the James River Association the unconditional right to use me/my child’s name, voice, and photographic likeness of me/my child in connection with any of their audio video production, articles, website materials or press releases, but not as an endorsement.