COVID Release Statement
Please read and review the following COVID release statement and complete registration by filling out the signature form:
Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), River Valley Church is taking extra precautions and enhanced sanitation/disinfecting procedures in compliance with CDC guidance.
Symptoms of COVID-19 include:
• Fever
• Fatigue
• Dry Cough
• Difficulty Breathing
I agree to the following:
• I understand the above symptoms and affirm that I/my child, as well as all household members, does not currently have, nor have experienced the symptoms listed above within the last 14 days.
• I affirm that I/my child, as well as all household members, has not been diagnosed with COVID-19 within the past 30 days.
• I affirm that I/my child, as well as all household members, has not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days.
• I affirm that I/my child, as well as all household members, has not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days.
• I understand that River Valley Church of Christ cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.
By signing below, I agree to each statement above and release River Valley Church of Christ, its staff and volunteers from any
and all liability for unintentional exposure or harm due to COVID-19.