BCT Services Waiver (Vaccine Interest)
The New River Valley Business Continuity Team (BCT) assists businesses impacted by COVID-19. The BCT delivers wrap around services necessary for businesses to operate in the COVID environment. The BCT works in coordination with the New River Health District-Virginia Department of Health to provide employers with 24/7 technical assistance. Resources available include development of a business-specific continuity plan, public and employee messaging and education, facility cleaning, certification of best practices and coordination of on-site testing. This program is funded in part by a community development block grant through the Virginia Department of Housing and Community Development.
Submission of this form indicates that I hold harmless and indemnify the NRV Regional Commission, any and all partner entities, and all officers, departments, agencies, agents and employees thereof from and against any and all claims, losses, damages, injuries, fines, penalties, costs including court costs and attorney fees, charges, liability or exposure, however caused, resulting from, arising out of, or in any way connected with my participation in this program.
New River Valley Regional Commission
6580 Valley Center Drive Suite 124
Radford, VA 24141
* Required
Business Industry
Your answer
How many employees interested in being vaccinated?
Your answer
Name
*
Your answer
Email
Your answer
Phone Number
*
Your answer
Organization/Business Name
*
Your answer
Business Address
Your answer
Number of Employees
*
Your answer
Is the business women owned (51% or more)?
Yes
No
Clear selection
Is the business minority owned( 51% or more)?
Yes
No
Clear selection
Describe in no more than two sentences how COVID-19 has impacted your business or organization?
Your answer
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