COVID-form

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Covid-19 Liability waiver & consent form
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  ARCHDIOCESE OF MOBILE PARENTAL/GUARDIAN COVID-19 CONSENT FORM AND LIABILITY WAIVER
  
  Participant Info
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sex REQUIRED Please fill out this field.
  
  Parent/Guardian
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Business or Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and as a result, social distancing is recommended.
  Our Savior Parish/School will follow state and local standards of conduct and has put in place reasonable preventative measures to reduce the spread of COVID-19 at its Our Savior Parish/School activity (including but not limited to summer camp). However, even though such standards will be followed and reasonable measures put into place, Our Savior Parish/School cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Our Savior Parish/School activity could increase your risk and your child(ren)’s risk of contracting COVID-19.
  
  By signing this agreement, I acknowledge the contagious nature of COVID-19 and that my child(ren) and I may be exposed to or infected by COVID-19 by participating in the Our Savior Parish/School 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 Our Savior Parish/School may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Our Savior Parish/School employees, volunteers, and program participants and their families.
  
  Considering the foregoing, however, I, First Name Last Name , grant permission for my child, First Name Last Name , to participate in this parish activity that may require transportation to a location away from the parish site, notwithstanding the risks associated with the COVID-19 virus and group activities.
  
  I confirm that there are no necessary changes to the Medical Information Consent form for my child that I previously submitted. If there are any necessary changes, I will complete another Medical Information Consent form.
  
  I further agree on behalf of myself, my child named herein, and my spouse, our heirs, successors, and assigns, to release, indemnify, and hold harmless Our Savior Parish/School and The Roman Catholic Church of the Archdiocese of Mobile, their members, directors, officers, employees, agents and representatives (“Indemnitees”) associated with the event arising from or in connection with the negligent acts or omissions of the Indemnitees ONLY in regard to prevention of the spread of the COVID-19 virus. I SPECIFICALLY ACKNOWLEDGE AND AGREE TO THE FOREGOING.
  
  By checking this box and entering my FULL NAME below, I agree to the above statement of consent and waiver of liability. REQUIRED I agree. Please fill out this field.
  
  Enter FULL NAME Here (Parent/Guardian) REQUIRED Please fill out this field. Please enter valid data.
  
  Submit
  
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