KBIA COVID-19 MEMBER WAIVER AND DECLARATION

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In consideration of being allowed to participate at Kennebunk Beach Improvement Association (KBIA) in programming and related events and activities, the undersigned acknowledges, appreciates, and agrees that:
1. Participation includes an inherent risk of exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19, despite the health and safety measures taken by RELEASEES to reduce that risk; and
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and
3. I willingly agree to comply with the health and safety measures required by KBIA and recommended by the CDC and the State of Maine regarding preventing the spread of infectious diseases. If I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring it to the attention of the nearest KBIA employee immediately; and
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS KBIA its directors, officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

Email *

Additionally, I verify the following: *

The participant had their temperature taken today (the day of programming) and it was BELOW 100.4 degrees Fahrenheit (38 degrees Celsius).

The participant has not had any symptoms of COVID-19 (including but not limited to fever, cough, shortness of breath, loss of sense of taste or smell, fatigue) WITHIN THE PAST 14 DAYS.

The participant has not knowingly been in contact with any person(s) who were sick with any infectious diseases, including but not limited to MRSA, influenza, and COVID-19 WITHIN THE PAST 14 DAYS.

Should the participant become ill with any infectious disease within 14 days of participating in KBIA programming, they will contact KBIA immediately. KBIA will not share the personal identity of the participant but will inform other KBIA employees, agents and/or participants of potential exposure at its discretion.

Travel: I certify a. I/we have not left the state of Maine for any reason except daily essential travel in the past 14 days; OR b. I/we have traveled to Maine from another state, and I have completed a 10-day self-quarantine**; **a 10-day quarantine may be ended early with a negative antigen or molecular test result for COVID-19 on a specimen taken no longer than 72 hours prior to my arrival, consistent with Maine CDC guidance. NOTE: Travel and returning to Maine by a fully vaccinated individual does not require quarantine, after 14 days has passed since receiving the final dose.

Required

Participant First Name *

Participant Last Name *

Today's Date *

YYYY

Cell Phone Number *

If you are experiencing any symptoms related to MRSA, influenza or COVID-19, you must refrain from participating in KBIA programming today and contact the office. You will not be charged if you must cancel for reasons of illness or potential exposure to an infectious disease. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. *

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