ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT RELATING TO COVID-19 EXPOSURE, COVID-19 LIABILITY, AND COVID-19 RISKS
Name of Participant’s Parent or Legal Guardian signing below:
IN CONSIDERATION for myself and/or my child listed above being permitted to utilize the services,
utilize the facilities and/or participate in the programs of the Town of Bethlehem, Bethlehem Youth
Football, Inc. and its board of directors, managers and coaches (collectively the “Organization”), including,
but not limited to, observation or use of facilities or equipment, or participation in or acting as a spectator
during any program affiliated with the Organization, the undersigned, on behalf of himself or herself and
such participating child and any personal representatives, heirs, and next of kin (hereinafter referred to
as the undersigned) hereby acknowledges, agrees and represents that he or she has inspected and
carefully considered such premises, equipment, and facilities and has considered the Organization’s
programs and that the undersigned finds and accepts same as being safe and reasonably suited for the
use or participation by the undersigned and such participating children.
In addition, the undersigned acknowledges that novel coronavirus (COVID-19) infections have been
confirmed throughout the United States, including several cases in the undersigned’s own State and
locality. In accordance with the most recent guidance and recommendations issued by the World Health
Organization (WHO), the Centers for Disease Control and Prevention (CDC), undersigned’s own State’s
Department of Health (DOH) for slowing the transmission of COVID- 19, the undersigned hereby agrees,
represents, and warrants that neither the undersigned nor such participating child shall visit or utilize
the facilities, services, and/or programs of the Organization (other than any exclusively online services
and programs) within 14 days after: (i) returning from highly impacted areas subject to a CDC Level 3
Travel Health Notice; (ii) exposure to any person returning from areas subject to a CDC Level 3 Travel
Health Notice; or (iii) exposure to any person who has a suspected or confirmed case of COVID-19. The
CDC Travel Health Network is continuously updating this list and the undersigned agrees that they are
aware of this list and the countries listed. The undersigned agrees to check on a daily basis the CDC
Travel Health Notices list (
https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html) prior to
participating in or utilizing the facilities, services, and programs of the Organization. The undersigned
hereby agrees, represents, and warrants that neither the undersigned nor such participating child shall
participate in, visit or utilize the facilities, services, and/or programs of the Organization if he or she (i)
experiences symptoms of COVID-19, including, without limitation, fever, cough, loss of sense of taste or
smell, or shortness of breath, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. The
undersigned agrees to notify the Organization immediately if he or she believes that any of the foregoing
access/use restrictions may apply.
The Organization has taken certain steps to implement certain recommended guidance and
recommendations issued by public health agencies for slowing the transmission of COVID-19, including,
without limitation, the access/use restrictions set forth above. The undersigned acknowledges and agrees
that the Organization may revise its procedures at any time based on updated recommended guidance
and recommendations issued by public health agencies and further agrees to comply with the
Organization’s revised procedures prior to utilizing the facilities, services, and/or prior to participating in
the programs of the Organization. The undersigned further acknowledges and agrees that, due to the
nature of the facilities, services, and programs offered by the Organization, social distancing of six feet per
person among children and their fellow participants or others is not always possible. The undersigned fully
understands and appreciates both the known and potential dangers of participating in the programs
and/or utilizing the facilities and services of the Organization and acknowledges that use thereof by the
undersigned and/or such participating children may, despite the Organization’s reasonable efforts to
mitigate such dangers, result in exposure to COVID-19, which could result in quarantine requirements,
serious illness, disability, and/or death.
IN FURTHER CONSIDERATION OF BEING PERMITTED TO PARTICIPATE IN THE ORGANIZATION’S
PROGRAMS, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:
THE UNDERSIGNED, ON HIS OR HER BEHALF AND ON BEHALF OF SUCH PARTICIPATING
CHILD, HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the
Organization, or any of their respective directors, officers, employees, volunteers and agents, or any of
the fellow participants or their family members or guests from all liability to the undersigned or such
participating children and all personal representatives, assigns, heirs, and next of kin of the undersigned
or such participating children for any loss or damage, and any claim or demands on account of any
property damage or any injury to, or an illness or the death of, the undersigned or such participating
children (or any person who may contract COVID-19, directly or indirectly, from the undersigned or such
participating children) related to COVID-19 or related illnesses, whether caused by the negligence, active
or passive, of the Organization or otherwise while the undersigned or such participating children are in,
upon, or about the premises or any facilities or using any equipment of or participating in any program of
or affiliated with the Organization.
THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS the
Organization and any of their respective directors, officers, employees, volunteers and agents, and each
of them, from any loss, liability, damages or costs they may incur related to COVID-19 or related illnesses,
whether caused by the Organization’s negligence, active or passive, or otherwise while the undersigned
or any participating child is participating in any program of the Organization or in, upon, or about the
premises or any facilities or equipment affiliated with the Organization. The undersigned understands and
agrees that the Organization is not required to provide insurance to cover the undersigned or such
participating children in the event they suffer illness, injury, death, property loss, theft or damage of any
sort upon, or about the premises or any facilities or equipment therein or while participating in any
program affiliated with the Organization.
The undersigned agrees and acknowledges that use of the Organization facilities and services, and
participation in the Organization programs, may involve inherent danger and risk related to COVID-19 or
related illnesses, including, without limitation, the risk of physical illness or injury, death or property
damage. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR, AND RISK OF
ILLNESS, BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such participating
children due to negligence, active or passive, or otherwise while in, about or upon the premises of the
Organization and/or while using the premises or any facilities or equipment thereon and/or while
participating in or observing any program affiliated with the Organization. The undersigned acknowledges
that any illness or injuries that the undersigned or such participating children contract or sustain may be
compounded by negligent first aid or emergency response of the Releases and waive any claim in respect
thereof.
THE UNDERSIGNED further expressly agrees that the foregoing ASSUMPTION OF RISK, RELEASE
AND WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT is intended to be as broad and inclusive
as is permitted by the laws of the State in which the undersigned resides or participates and that if any
portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal
force and effect.
I HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND
WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT AND FURTHER AGREE THAT NO ORAL
REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN
AGREEMENT HAVE BEEN MADE. I AM AWARE THAT BY AGREEING TO THIS AGREEMENT I AM
GIVING UP VALUABLE LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES FROM
THE ORGANIZATION IN CASE OF ILLNESS, INJURY, DEATH OR PROPERTY LOSS OR DAMAGE,
INCLUDING, FOR THE AVOIDANCE OF DOUBT AND WITHOUT LIMITATION, EXPOSURE TO COVID-
19 AT ANY ORGANIZATION FACILITY OR DURING PARTICIPATION IN ANY PROGRAM AND ANY
ILLNESS, INJURY OR DEATH RESULTING THEREFROM. I UNDERSTAND THAT THIS DOCUMENT
IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDEMNIFICATION FOR ALL CLAIMS. IF
SIGNING ON BEHALF OF MINOR: I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON
BEHALF OF MY MINOR
CHILD AND/OR LEGAL WARDS AND I REPRESENT AND WARRANT TO THE ORGANIZATION
THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S).
