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COVID-19 Activity Waiver

Dear Good Deeds Day Participant,

We are thrilled that you have chosen to participate in an Agudas Achim activity. Because we care about your physical health, as well as your social-emotional needs, it is important to understand the inherent risks of in-person activities. Please read the statement below and sign and submit the form electronically prior to participating in an event. 

Acceptance of Risk Relating to Coronavirus/COVID-19

(updated November 20, 2020)

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization and is prevalent in the United States including the Commonwealth of Virginia. COVID-19 is extremely contagious. People reportedly can be infected and show no symptoms and therefore spread the disease. Evidence has shown that COVID-19 can cause serious and potentially life-threatening illness and even death.

Agudas Achim Congregation of Northern Virginia (also known as “Agudas Achim”) is following and applying the best current guidance to prevent transmission of this disease. Nevertheless, it cannot guarantee that you [or your child(ren)] will not be exposed to or contract COVID-19 while participating in Agudas Achim’s services, activities, or using its premises. Therefore, if you choose to participate in services or activities provided by an Agudas Achim provider and/or enter onto Agudas Achim’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept for myself and/or my children the risk of contracting COVID-19 in order to participate in Agudas Achim’s services and/or activities and/or enter Agudas Achim’s premises. These services are of such value to me [and/or to my children,] that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Agudas Achim’s services and premises in person.

WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against Agudas Achim and its officers, directors, managers, officials, agents, employees, or other representatives in connection with my potential exposure to and infection by COVID-19 incurred in connection with participating in Agudas Achim’s services, activities, and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence, and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.

CHOICE OF LAW: I understand and agree that the law of the Commonwealth of Virginia will apply to this agreement.

BY TYPING MY FULL NAME BELOW, I CONFIRM THAT I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE.

 

Sat, July 31 2021 22 Av 5781