Harlequin Stables Assumption of Risk and Waiver of Liability Related to the Coronavirus/COVID-19
This waiver must be completed for all those coming to Harlequin Stables (riders/students, parents/guardians, helpers, volunteers, employees, boarders, and other visitors), located at 215 High St, Westwood, MA, 02090, prior to entering the premises. Due to the coronavirus pandemic, we have transitioned to using mostly online forms to minimize contact and risk of exposure. Thank you.
Email address *
Harlequin has put in place preventative measures to reduce the spread of Coronavirus/COVID-19, and will be following all the guidelines provided by the Department of Public Health. However, Harlequin Stables cannot guarantee that you will not become infected with Coronavirus/COVID-19. By coming to Harlequin Stables you understand and acknowledge the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions or negligence of yourself and others, including, but not limited to, Harlequin staff, and other riders and their families. With the understanding that leaving your home or going anywhere increases your risk of contracting COVID-19, you acknowledge the contagious nature and that the CDC and many other public health authorities still recommend practicing social distancing and voluntarily assume the risk of exposure. Furthermore, you acknowledge that you voluntarily seek services provided by Harlequin Stables and that you, your child, and any personal representatives must comply with all set procedures to reduce the spread while on the premises.
All guidelines emailed out and posted must be abided by with special attention to the following:Harlequin requires self-administered temperature checks for everyone coming to Harlequin (staff, volunteers, riders, and caretakers) immediately before coming to Harlequin. Anyone with a fever should not come to Harlequin. (Harlequin reserves the right to conduct temperature checks as needed.)Everyone, over the age of two, who can, is required to wear a mask or face covering while at Harlequin Stables. Everyone will wash their hands or use sanitizer upon entering the property. (Hand washing is your best self-defense against the spread of germs. As a backup, we have additional antibacterial hand sanitizer readily available to you in the main barn.)Everyone must commit to social distancing (6-10ft or more) while they are at Harlequin Stables and outside of Harlequin Stables. Anyone who is ill, or exposed to someone who is ill, should not come to Harlequin Stables and will be sent home immediately.
I attest that I, my child/children, and any personal representatives:Am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty of breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. Acknowledge and verify before coming to Harlequin that my temperature, my child/children’s temperature, and any other visitors in your party is within normal range with no sign of fever. Have not traveled internationally within the last 14 days. Have not traveled to a highly impacted area within the United States of America in the last 14 days. Do not believe I have been exposed to someone with a suspected an/or confirmed case of the COVID-19. Have not been diagnosed with COVID-19 and not yet cleared as non contagious by state or local public health authorities. Am following CDC recommended guidelines as much as possible and limiting my exposure to COVID-19.
I have read, understand, and am voluntarily signing this Assumption of Risk and Waiver of Liability Related to COVID-19. On behalf of myself, my children, and any caregivers that may attend with my children, I hereby release, covenant not to sue, discharge, or hold harmless Harlequin Stables, its employees, agents, or representatives of and from any claims, including liabilities, actions, damages, cost, or expenses of any kind arising out of, or relating to, whether a COVID-19 infection occurs before, during, or after visiting Harlequin Stables. I understand that this release discharges Harlequin Stables from any liability or claim that I, my heirs, or any personal representatives may have against Harlequin Stables with respect to any bodily injury, illness, death, or medical treatment that may arise from, or in connection to, any services received from Harlequin Stables. This liability waiver and release extends to Harlequin Stables together with all owners, partners, and employees.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE IS EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Rider/Helper/Volunteer/Employee/Boarder/Visitor Name: *
Name of Parent/Guardian:
Today's Date: *
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I have read, understand, and agree to the terms and conditions listed above. *
Required
Electronic Signature - Full Name of Rider/Helper/Volunteer/Employee/Boarder/Visitor if Over 18:
Electronic Signature - Full Name of Parent/Guardian if Rider/Helper/Volunteer/ is Under 18:
A copy of your responses will be emailed to the address you provided.
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