Loading...

COVID-19 Liability Release Waiver 

 

Worldwide pandemic.The World Health Organization has declared the Novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person to person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which The Murder Collective adheres to comply.

In consideration of my participation in the foregoing, the undersigned acknowledge and agree to the following.


I am aware of the existence of the risk on my physical appearance to the venue in my participation to the activity of the organization that may cause injury or illness such as, but not limited to influenza, MRSA, or COVID-19 that may lead to paralysis or death.


 I have not experienced symptoms that a fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms related to COVID-19 or any communicable disease within the last 14 days.


 I have not, nor any members of my household, travel by C or by air, internationally within the past 30 days.


 I did not nor any member of my household, visit any area within the United States that was reported to be highly affected by COVID-19, in the last 30 days.


I have not, nor any members of my household, been diagnosed to be infected with COVID-19 virus within the last 30 days.

Following the pronouncement above I hereby declare the following;


 I am fully and personally responsible for my own safety and actions while and during my participation and recognize that I may be in any case at risk of contracting COVID-19.

 

 

First Client Name

First Name*

Middle Name

Last Name*
First Client Date of Birth*
First Client Signature*
Second Client Name

First Name*

Middle Name

Last Name*
Second Client Date of Birth*
Third Client Name

First Name*

Middle Name

Last Name*
Third Client Date of Birth*
Fourth Client Name

First Name*

Middle Name

Last Name*
Fourth Client Date of Birth*
Fifth Client Name

First Name*

Middle Name

Last Name*
Fifth Client Date of Birth*
Sixth Client Name

First Name*

Middle Name

Last Name*
Sixth Client Date of Birth*
Seventh Client Name

First Name*

Middle Name

Last Name*
Seventh Client Date of Birth*
Eighth Client Name

First Name*

Middle Name

Last Name*
Eighth Client Date of Birth*
Ninth Client Name

First Name*

Middle Name

Last Name*
Ninth Client Date of Birth*
Tenth Client Name

First Name*

Middle Name

Last Name*
Tenth Client Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!