COVID Screening and Consent Form

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To be performed no earlier than 24 hours before your event

Email *

Contact Tracing Phone Number *

Name *

Are you currently experiencing any of these symptoms *

Fever and/or chills

Cough or barking cough

Shortness of breath

Sore throat

Difficulty swallowing

Runny or stuffy/congested nose

Decrease or loss of taste or smell

Pink eye

Headache

Digestive issues like nausea/vomiting, diarrhea, stomach pain

Muscle aches/joint pain

Extreme tiredness

Falling down often

NONE OF THE ABOVE

Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? *

Yes

In the last 14 days, have you travelled outside of Canada and been told to quarantine (per the federal quarantine requirements)? *

Yes

In the last 14 days, have you or someone you live with been identified as a “close contact” of someone who currently has COVID-19? *

Yes

In the last 14 days, has anyone you live with: travelled outside of Canada and been told to quarantine (per the federal quarantine requirements)? *

Yes

Has a doctor, health care provider, or public health unit told you or anyone in your party that you should currently be isolating (staying at home)? *

Yes

In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? *

Yes

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 EveryBODY on Stage (the "Organization") adheres to comply. In consideration of my participation in the foregoing, I acknowledge and agree to the following: *

With full knowledge of the risks involved, I hereby release, waive, discharge the Organization, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.I agree to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19. I agree to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19

I agree to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.

By filling out this form I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my 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.

Required

This agreement releases EveryBODY on Stage and producers/performers and staff from all liability relating to injuries that may occur during the event. By signing this agreement, I agree to hold the organizers entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence.I also acknowledge the risks involved in the event. I swear that I am participating voluntarily, and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity. By signing below I forfeit all right and the rights of my party to bring a suit against the organizers for any reason. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. I will ask for clarification when needed. *

I Agree

A copy of your responses will be emailed to the address you provided.

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