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 which The Palestinian American Community Center adheres to comply with. As a participant, the parent, or visiting member at the Palestinian American Community Center, I am aware of the potential spread of COVID-19 that could result in severe illness and potential death, and that my actions may affect the health of those around me Therefore, I will, to the best of my ability, practice proper social distancing at work and outside of the office as recommended by health department directives, as well as practice good hygiene(handwashing, use of hand sanitizer, wearing of a mask when required, etc.) and follow other health recommendations. Should I become ill, I promise to self-report the illness and contact PACC to let them know of my condition. I will adhere to testing guidelines and work with my own primary care providers. Finally, if I am exposed or suspected to be exposed to COVID-19, I will self-quarantine and notify all parties that may be involved. For more information on what PACC is doing to keep you safe click here to see our protocol:
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In consideration of your child(ren) participation in the foregoing PACC Programs, the undersigned acknowledge and agree to the following: *
Following the pronouncements above my child(ren) and I hereby declare the following: *
In addition to COVID liability my child(ren) and I acknowledge and agree to the following: *
By signing below my child and I acknowledge that we have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old or a parent/guardian and fully competent to give my consent and consent on behalf of my child(ren)(a minor 17 or under); That we (my child(ren) and I) have been sufficiently informed of the risks involved and give our voluntary consent in signing it as our own free act and deed; that we (my child(ren) and I) give our voluntary consent in signing this Liability Release Waiver as our own free act and deed with full intention to be bound by the same, and free from any inducement or representation. This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted. *
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Virtual Signature *
Date Signed *
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