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Participant Liability Release and Waiver

I understand that my decision to participate in a Life Center’s (LC) activities is entirely voluntary. For and in consideration of my being permitted to participate in LC, I fully accept the responsibility and assume the risk of any injury or damage suffered by me, either directly or indirectly, while participating. I understand that the LC does not assume any responsibility for my safety in connection with LC activities.

I hereby expressly release, discharge, and hold harmless LC, Fountain of Life Center, Life Center Academy and all affiliated organizations, its officers, agents, and employees from any liability and claims resulting from damage and/or injury to my person or property in connection with LC activities.

I further agree to indemnify and hold harmless from all claims, costs, liabilities, expenses or judgments arising out of any loses, damages, illness, deaths, or other casualties suffered by me or any other person, LC, Fountain of Life Center, Life Center Academy and all affiliated organizations in connection with my participation in LC activities.

It is my intention, by this instrument, to exempt LC, Fountain of Life Center, Life Center Academy and all affiliated organizations, and relieve from liability for personal injury, property damage or wrongful death caused by negligence or otherwise, to the full extent of applicable laws. I agree that under no circumstances will I prosecute or present any claim for personal injury, property damage or wrongful death against the LC, Fountain of Life Center, Life Center Academy and all affiliated organizations, arising out of or connected in any way with my participation in or presence at LC activities at any time, whether as a result of LC, Fountain of Life Center, Life Center Academy and all affiliated organizations.

Coronavirus Liability Release and Waiver

The BURLINGTON ASSEMBLY OF GOD-FOUNTAIN OF LIFE CENTER, is a New Jersey nonprofit corporation (the “Owner”), that owns and operates the Life Center (the “Life Center”), principally located at 2035 Columbus Road, Burlington, NJ 08016. In consideration for allowing me (and my dependents) to enter the Life Center to participate in activities hosted by the Sponsoring Organization (the “Organization”) or Event Host at the Life Center, I, on behalf of myself and my dependents, acknowledge and agree to the terms of this Coronavirus Liability Release and Waiver (the “Waiver”), as evidenced by my signature below:

1. I am entering the Owner’s premises as a guest of the Organization or Event Host, and the Owner is allowing the Organization or Event Host and its guests to use the Life Center only if a signed waiver, in this form, is obtained from each guest.

2. The World Health Organization (“WHO”) has declared the novel Coronavirus (COVID-19) a worldwide pandemic. While the state of medical knowledge is evolving, it is known that the virus has the capacity to transmit from person-to-person through respiratory droplets and/or by contact with contaminated surfaces and objects. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known cure for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death.

3. The Centers for Disease Control and Prevention (“CDC”), the New Jersey Department of Health, and many local jurisdictions have set forth guidelines to prevent the spread of the virus, which the Life Center and persons entering the Life Center must comply with, including but not limited to, social distancing measures, increased hand-washing and other hygienic practices, and frequent cleaning of common surfaces.

4. However, it is not possible to prevent the presence of COVID-19 at any premises. Accordingly, I am aware that the Owner cannot prevent me or my dependents from becoming exposed to, contracting, or spreading COVID-19 while at the Life Center or utilizing any of its facilities or services. Therefore, if I (or my dependents) freely choose to enter the Life Center’s premises, rather than arranging for an alternative method of enjoying the same services, activities, or events virtually (e.g. virtual conferences or events), and utilize the Life Center’s facilities in person, I (or my dependents) may be exposed to and/or have an increased risk of contracting or spreading COVID-19.

5. I, on behalf of myself and my dependents, understand and hereby assume any and all COVID-19 risks associated with entering and utilizing the Life Center’s premises, including, but not limited to, any risks that may arise from contracting COVID-19 due to the negligence of the Owner and each of its affiliates, including, but not limited to, any of its owners, officers, directors, managers, officials, trustees, agents, employees, volunteers, representatives, successors or assigns (the “Released Parties”), and hereby knowingly release the Owner from any and all liability from any medical condition or illness (including without limitation COVID-19) contracted while using the Life Center’s facilities. This Coronavirus Liability Release and Waiver (the “Waiver”) fully and forever releases Owner or any Released Party from any and all responsibility of any nature to me and/or my dependents arising from or in any way related to exposure to the COVID-19 virus while participating in activities at the Life Center, even if the exposure results from the negligence of a Released Party. I hereby forever release and waive my right to bring suit, whether on behalf of me or any of my dependents, against Owner or any Released Party, in connection with exposure, infection, and/or spread of COVID-19 related to participating in any event or activity at the Life Center, including without limitation any claims for personal injuries, physical injuries, bodily harm, death, disease or property losses, or any other loss, including but not limited to claims of negligence, and I, on behalf of myself and my dependents, give up any rights to seek damages from the Owner or any Released Party with respect to any such claim, whether known or unknown, foreseen or unforeseen.

6. Neither I nor any dependent will enter the Life Center premises for any reason if such person (or any member of their household) has:

a. experienced symptoms of fever, fatigue, difficulty in breathing, or dry cough or exhibited any other symptoms relating to COVID-19 during the 14 day period prior thereto;

b. has been diagnosed or infected with COVID-19 and not medically cleared for participation in activities outside their home.

7. I understand and agree that the laws of the State of New Jersey will apply to this Waiver and this Waiver of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS WAIVER, AND FREELY AND KNOWINGLY ASSUME THE RISKS AND WAIVE ANY AND ALL RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE. 

I Agree

I am the parent or legal guardian of the minor(s) named above. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Waiver.

Today's date: May 26, 2022

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Event Group Field
With my signature below, I certify that I (or parent or legal guardian if participant is under 18 years of age) have read and understand this Release and Waiver. I further certify that it is my intention, by signing this Release and Waiver that it is binding upon my heirs, administrators, executors, successors, and assigns. I am signing this Release and Waiver voluntarily and understand that it is legally binding.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
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.


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