LWA Covid Security Clearance Procedures for Guests
Due to Covid-19, all guests must be announced.  All guests must be approved.  All guests must complete this questionnaire if not in the Magnus App.  All guests must have picture identification.  All guests must provide contact information for contact tracing.  Guests may not take pictures/videos of, or interact with, students for any reason devoid of the head of school's written permission and prior notice.  All guests must complete this form PRIOR to arrival at LWA.  All guests must park in appropriate parking spaces and enter and exit through the main school door only.  Guests must call 516-374-9000 to cancel appointment or announce appointment/obtain directions if needed.  GUESTS WILL NOT BE PERMITTED IN THE BUILDING DEVOID OF MASKS.  Guests will be confined to visiting hours after student dismissal unless an emergency situation.      

Sign in to Google to save your progress. Learn more
Last Name *
First Name *
Company/Affiliation *
Title/Role *
Email *
Mobile Phone Number *
Purpose of Visit *
Person Visiting/Receiving/LWA Contact Point *
Duration of Visit (Anticipated) *
Mandatory Covid-19 Health Screening Questions
In the past 48 hours, have you experienced any of the following:  sore throat, headache, congestion, runny nose, or diarrhea, nausea, vomiting, chills or fever (100 degrees Fahrenheit or above), or shortness of breath, or difficulty breathing, or new loss of taste or smell, or have you experienced any of the following:  cough, muscle or body aches, excessive fatigue? *
Are you currently waiting for Covid-19 test results or are you isolating or quarantining because you may have been exposed to a person with Covid-19 or are worried that you may be sick with Covid-19?? *
Within the past 10 days, have you been in close physical contact (6 feet or closer) for a total of 15 minutes or more over a 24 hours period with a person who is known to have laboratory confirmed Covid-19, or with anyone who has any symptoms consistent with Covid-19? *
Have you traveled internationally or from a state with widespread community transmission of Covid-19, per the New York State Travel Advisory in the past 10 days? *
I confirm that my answers to these survey questions are accurate and true to the best of my knowledge. *
All students, staff, family, guests, contractors, or visitors to LWA Campus must read, agree to, and click yes/accept this arbitration and release, waiver of liability document/policy below FOR PERMISSION TO ENTER LWA PREMISES OR OFFSITE LOCATIONS, FOR SCHOOL, WORK, EVENTS, ETC. ANYONE ENTERING THE LWA CAMPUS OR OFFSITE EVENT DEVOID OF AGREEING TO THIS RELEASE/AGREEMENT IS DOING SO DEVOID OF AUTHORIZATION. LAWRENCE WOODMERE ACADEMY ARBITRATION AND RELEASE, WAIVER OF LIABILITY, REPRESENTATIONS AND COMPLIANCE AGREEMENT FOR ON-CAMPUS AND IN-PERSON EVENTS (LWA Covid Waiver) Welcome to the Lawrence Woodmere Academy (“the Academy”). We are pleased to welcome students, family members, friends, volunteers, visitors, and spectators to on-campus and/or in-person events at our school throughout the year. As a result of the current pandemic, however, we ask that you read carefully before signing this Arbitration and Release, Waiver of Liability, Representations, and Compliance Agreement (“this Agreement). This Agreement has legal consequences and will affect your legal rights and ability to bring future legal actions against the Academy. This Agreement also includes an arbitration provision and a waiver of your right to bring or participate in a class action. I understand and acknowledge that the novel coronavirus SARS- CoV-2 and any resulting disease (together with any mutation, adaptation, or variation thereof, “COVID-19”) is a serious disease that has caused numerous changes to our society and the way individuals must act to help protect against the disease and the spread of the disease. In consideration of being permitted to enter and remain at the Academy premises (the “Premises”) as a visitor and/or spectator for an on-campus and/or in-person event during the upcoming year (“Event”), I, on behalf of myself and my heirs, assigns, executors, administrators, and anyone attending an Event with me (“Related Persons”), hereby acknowledge and agree to be bound by the terms and conditions of this Agreement. I acknowledge that the terms and conditions of this Agreement are in addition to all other terms and conditions that the Academy requires of its visitors. 1. ACKNOWLEDGEMENTS OF COVID-19 & OTHER RISKS. I fully understand that: (a) COVID-19 is an extremely contagious disease that can lead to severe illness and death, and there is an inherent danger and risk of exposure to COVID-19 in any place where people are present; (b) no health and safety policies, assessments, precautions and/or protocols that will be implemented from time to time at and for the Premises (collectively, the “Premises Protocols”) by local, state and federal governmental agencies, the Academy, and its affiliated companies, can eliminate the risk of exposure to COVID-19; (c) while people of all ages and health conditions can be and have been adversely affected by COVID-19, according to the Center for Disease Control and Prevention (“CDC”) and other public health authorities (i) people with certain underlying medical conditions are or may be especially vulnerable, including, but not limited to, people with chronic kidney disease, chronic obstructive pulmonary disease, moderate to severe asthma, liver disease, compromised immune systems (including as a result of organ transplant), obesity, serious heart conditions, sickle cell disease, and type 2 diabetes, and (ii) the risk of severe illness from the contraction of COVID-19 increases steadily with age, and contracting COVID-19 can result in the further transmission of COVID-19 to my family members and other persons in proximity to me; and (d) exposure to COVID-19 can result in subsequent quarantine, illness, disability, other short-term and long-term physical and/or mental health effects, and/or death, regardless of age or health condition at the time of exposure and/or infection. 12. REPRESENTATIONS AND AGREEMENT TO COMPLY. I hereby represent and affirm, on behalf of myself and Related Persons, that I will attend an Event only if (a) I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell; (b) I have not traveled out of the State of New York within 14 days prior to the Event; (c) I have no reason to believe I was exposed to someone with a suspected and/or confirmed case of COVID-19; (d) I have not been diagnosed with COVID-19 and have not been directed to quarantine by state or local public health authorities within 14 days prior to the Event; (e) I follow all federal, state, and/or local public health authorities’ recommended guidelines related to COVID-19 as much as possible and have been limiting my exposure to COVID-19 to the best of my abilities; and (f) I will comply with the protocols of the Academy while on the Premises, including (i) maintaining social distancing at a minimum six-foot distance from others; (ii) maintaining a facial covering; and (iii) washing/disinfecting my hands when appropriate. 3. ASSUMPTION OF RISKS, HAZARDS AND DANGERS. I, on behalf of myself and Related Persons, hereby fully understand and knowingly, voluntarily, and irrevocably assume all risks, hazards, and dangers related to entry into, and presence in, at, and around the Premises, which may include an increased risk of exposure to communicable diseases (including, without limitation, COVID-19), which might result from the actions, inactions, or negligence of myself, any of the Released Parties (as defined below), or other third parties, whether occurring before, during, or after an Event, however caused and whether inside, outside, or near the Premises. I HEREBY ACCEPT PERSONAL RESPONSIBILITY FOR MY VOLUNTARY ATTENDANCE AND/OR PARTICIPATION IN/AT AN EVENT. I HEREBY ASSUME, ON BEHALF OF MYSELF AND RELATED PERSONS, ALL RESPONSIBILITY OF CLAIMS AND POTENTIAL CLAIMS RELATING TO THE RISK, HAZARDS, AND DANGERS DESCRIBED IN THIS AGREEMENT. 4. RELEASE, WAIVER & COVENANT NOT TO SUE. (a) I, on behalf of myself and Related Persons, hereby fully understand and knowingly, voluntarily, irrevocably, and forever release, waive, and discharge (and covenant not to sue), each of the Released Parties with respect to any and all claims that I or any Related Persons may have (or hereinafter accrue) against any of the Released Parties, that relate to any of the risks, hazards, and dangers described above, including without limitation, any and all claims that arise out of or relate in any way to (I) my exposure to COVID-19; (II) any Related Person’s exposure to COVID-19, (III) my travel to and from, entry into, or presence at the Premises, and/or compliance with the policies, procedures, and protocols of the Academy; (IV) any interaction between myself and any personnel of any of the Released Parties present at the Premises (including, without limitation, Academy personnel, agents, or other invitees); and/or (V) any of the risks identified above (collectively “the Claims”), in each case whether caused by any action, inaction, or negligence of any Released Party or otherwise. (b) For the purposes hereof, the “Released Parties” are: (I) the Lawrence Woodmere Academy, its employees, agents, students, and invitees; (II) the direct and indirect owners, lessees, and sublessees of the Premises; (III) all third parties performing services at the Premises; and (IV) any parents, subsidiaries, affiliated and related companies and officers, directors, owners, members, managers, partners, employers, employees, agents, contractors, sub-contractors, insurers, representatives, successors, and/or assigns of each of the forgoing entities and persons, whether past, present, or future, and whether in their institutional or personal capacities. 5. ARBITRATION AGREEMENT. I hereby agree, on behalf of myself and Related Persons, that: (a) any Claim asserted by me against any of the Released Parties shall be resolved by mandatory, confidential, final, and binding arbitration to Judicial Arbitration and Mediation Services, Inc. (“JAMS”); (b) this Section 5 is governed by the Federal Arbitration Act (“FAA”); (c) the FAA is applicable because 2the Released Parties are engaged in transaction involving interstate commerce; (d) the arbitration shall proceed before a single arbitrator; (e) the arbitration shall be conducted in accordance with the JAMS Comprehensive Arbitration Rules and Procedures; (f) any and all issues relating or pertaining to arbitration or this arbitration clause, including but not limited to the threshold question of arbitrability or the enforceability or validity of this arbitration clause, shall be delegated to the arbitrator selected pursuant to this provision; (g) the arbitrator shall have the power to award any remedies, including reasonable attorneys' fees and costs, available under applicable law; (h) judgement upon the award rendered by the arbitrator may be entered in any court having jurisdiction; (i) the award may be vacated or modified only on the grounds specified in the FAA or other applicable law; and (j) any arbitration conducted pursuant to this Agreement shall take place in the State of New York. 6. CLASS ACTION WAIVER. I hereby agree that any and all disputes, including any Claims made by me against any of the Released Parties must be arbitrated on an individual basis only. By signing this Agreement, I hereby waive any right to litigate or arbitrate any Claim as a class action, representative action, or class arbitration against any of the Released Parties. 7. SEVERABILITY. I hereby agree that if any provision or part thereof contained in this Agreement is declared illegal, unenforceable, or ineffective, such provision or part thereof shall be deemed severable, such that all other provisions contained in this Agreement shall remain valid and binding. I HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS AGREEMENT. I understand its terms and I am aware of its legal consequences, including that I am hereby giving up substantial legal rights and that by signing this Agreement, I understand I am forever prevented from suing or otherwise asserting a Claim against any of the Released Parties. I understand that this Agreement is a material inducement for my entry and admission to the Premises and that the Lawrence Woodmere Academy and the other Released Parties are relying upon it. I agree that no oral representations, statements, or inducements contrary to anything contained herein have been made by the Lawrence Woodmere Academy or any other Released Parties. By clicking below I am affixing my signature to the aforementioned LWA Covid Waiver. * *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Lawrence Woodmere Academy. Report Abuse