LA Holiness Church Entry Screening & Waiver
In order to provide a record of attendance for contact tracing, an Entry Screening and Waiver is required for each attendee before entering the church premises.
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Name (First name, Last name) *
Cell Number *
For attendees under 18, you may use a phone number for a guardian
Waiver of Liability
I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren), spouse, and I may be exposed to or infected by COVID-19 by attending LA Holiness Church ("Church") or Church-related activities 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 Church or Church-related activities may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Church employees, volunteers, and Church-related activity 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), spouse, or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that my child(ren), spouse, and I may experience or incur in connection with my child(ren)’s attendance at the Church or participation in Church-related activities (“Claims”).

On my behalf, and on behalf of my spouse and children, I hereby release, covenant not to sue, discharge, and hold harmless the Church, its employees, agents, 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 Church, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Church-related activity.
I understand and agree that the law of the State of California will apply to this Waiver of Liability. *
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