City of Thorold: Assumption of Risk and Waiver: Coronavirus/ COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is a contagious disease and is believed to spread mainly from person-to-person contact.
The City of Thorold has put in place preventative measures at its facilities that meet or exceed recommendations from the Ontario Ministry of Health and Niagara Public Health Unit to reduce the spread of COVID-19 at its Recreation and Culture Programs, however the City of Thorold cannot guarantee that you or your child(ren) will not become infected with COVID-19 as a result of attending a City facility. Further, attending a Recreation or Culture Program or similar activity at a City facility could increase your risk and your child(ren)’s risk of contracting COVID-19.
I understand that this Assumption of the Risk and Waiver of Liability agreement is in addition to, and is not a substitute for, any other documentation or registration information that I might be required to execute by the City of Thorold in order for myself or my child(ren) to participate in a City of Thorold program or activity taking place in a City of Thorold facility.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that myself or my child(ren) may be exposed to or infected by COVID-19 by attending a program or activity and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the program or activity may result from the actions, omissions, or negligence of myself and others, including, but not limited to, the City of Thorold employees and volunteers, and program participants and their families.
I VOLUNTARILY AGREE TO ASSUME ALL OF THE FOREGOING RISKS AND ACCEPT SOLE RESPONSIBILITY FOR ANY INJURY TO MY CHILD(REN) OR MYSELF (INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURY, PERMANENT DISABILITY, AND DEATH), ILLNESS, DAMAGE, LOSS, LIABILITY, OR EXPENSE, OF ANY KIND, THAT I OR MY CHILD(REN) MAY EXPERIENCE OR INCUR IN CONNECTION WITH MY OR MY CHILD(REN)’S ATTENDANCE AT THE CITY OF THOROLD RECREATION AND CULTURE PROGRAMS (“CLAIMS”).
ON MY BEHALF, AND ON BEHALF OF MY CHILDREN,I HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, AND HOLD HARMLESS THE CORPORATION OF CITY OF THOROLD, ITS COUNCIL, MAYOR, COUNCILLORS, EMPLOYEES, AGENTS, VOLUNTEERS, AND REPRESENTATIVES, OF AND FROM THE CLAIMS, INCLUDING ALL LIABILITIES, CLAIMS, ACTIONS, DAMAGES, COSTS OR EXPENSES OF ANY KIND ARISING OUT OF OR RELATING THERETO.
I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of The City of Thorold, its Council, Mayor, councillors, employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any City of Thorold Recreation or Culture Program or activity taking place in a City of Thorold facility.
I understand that:
• Persons entering in an enclosed public space must wear a face covering as required under the Niagara Region Face Covering By-Law No-2020-46. More information on the by-law and exemptions can be found at
• Any person displaying symptoms outlined in the COVID-19 Reference Document for Symptoms or who has come in close contact with a person with symptoms of or a confirmed COVID-19 in the past 14 days, shall not attend the program or activity. Entry will be denied, or you will be asked to leave the program (caregiver will be contacted to pick up minors immediately) if symptoms are present.
• My personal information (name, contact information, time of arrival/departure, screening completing) will be collected to facilitate contact tracing in the event of a confirmed COVID-19 case or outbreak. This information is collected in order to provide social and recreation municipal services authorized by section 11 of the Municipal Act, 2001 in the context of the COVID-19 pandemic. I consent to have this personal information collected by the City and shared with any party in the City’s discretion without my further knowledge or consent in accordance with and governed by the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. M.56. If I have any questions about the collection, storage or use of my personal information I can contact the Clerks Department at the City of Thorold.
• City staff may have a duty to report suspected or confirmed cases of COVID-19 under the Heath Protection and Promotion Act, and emergency guidelines and protocols. The City of Thorold will report a participant suspected to have COVID-19 to Niagara Public Health. I consent to have this personal information collected by the City and shared with any party in the City’s discretion without my further knowledge or consent.
I have received this document prior to participating in the program or activity and have the opportunity to review it and ask any questions for clarification. In addition, I have the opportunity to review this document with legal counsel, if I choose to do so.
I shall inform City staff of any positive COVID-19 diagnosis received within 7 days of attending a City facility for the purpose of contact tracing. I consent to have this personal information collected by the City and shared with any party in the City’s discretion without my further knowledge or consent.
Sign in to Google
to save your progress.
First and Last name required.
Name of Guardian (for participants under 18)
Phone Number or email
I hereby agree to the terms and conditions specified in the City of Thorold: Assumption of Risk and Waiver: Coronavirus/ COVID-19 on behalf of myself AND/OR my child(ren).
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service