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COVID Vaccination Confirmation UPDATED

COVID-19 Liability Release Waiver

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 to which Har Sinai-Oheb Shalom Congregation (the “Organization”) will comply.
The following applies to the undersigned adults and any minor children accompanying them.
Wearing a facial mask, maintaining social distance and frequent hand sanitizing must be practiced.

In consideration of my participation in the forgoing, the undersigned acknowledge and represent the following:
 
  1. I am aware of the existence of the risk incurred by my physical appearance to the venue and my participation in the activity of the Organization that may cause injury or illness such as, but not limited to COVID-19 that may lead to illness or death.
  2. I have not experienced symptoms of fever, fatigue, difficulty breathing, or dry cough, or exhibited any other symptoms relating to COVID-19 within the last 14 days.
  3. I have not, nor has any member of my household, traveled internationally by sea or air within the last 30 days.
  4. I did not, nor did any member of my household, visit any area within the United States that was reported by the CDC or NIH: NIAID to be highly affected by COVID-19 in the last 30 days.
  5. Neither I nor any members of my household have been diagnosed with the COVID-19 virus within the last 30 days.
I agree my participation is undertaken on the following conditions:
 
  1. I am fully and personally responsible for my own safety and actions during my participation and I recognize that I may be in any case at risk of contracting COVID-19.
  2. I hereby release, waive, discharge the Organization, its Board, Officers, Employees and Volunteers from and against any and all liabilities, claims, demands, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury or death, that may be sustained by me related to COVID-19 while participating in, on or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.
  3. I agree to indemnify, defend, and hold harmless the Organization, its Board, Officers, Employees, and Volunteers from and against any and all costs, expenses, damages, lawsuits and or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury loss, or death from or related to COVID-19.
By signing below, I acknowledge that I have read the forgoing Liability Release Waiver and understand its contents: that I am at least eighteen (18) years old and fully competent to give my consent, that I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed.
By signing below, I acknowledge that I have read the forgoing Liability Release Waiver and understand its contents: that I am at least eighteen (18) years old and fully competent to give my consent, that I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed.
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Sat, December 4 2021 30 Kislev 5782