Waiver of Liability Relating to Coronavirus/COVID-19

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The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death.

CounterPulse cannot prevent you from becoming exposed to, contracting, or spreading COVID-19 while utilizing CounterPulse’s services or performance premises. It is not possible to prevent the presence of the disease. Therefore, if you choose to utilize CounterPulse’s services and/or enter onto CounterPulse’s performance premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. ______________________________________________________________________________

I am aware of the COVID-19 pandemic and related governmental orders, directives, and guidelines, including directives for frequent hand washing, social distancing, and use of face masks in public locations.
I have read and understood the above warning concerning COVID-19 and risks involved. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize CounterPulse’s services and enter CounterPulse’s premises or performance location.

WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against CounterPulse and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing CounterPulse’s services and performance premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen as it relates to COVID-19.

Please initial, print name, and date below.

Email *

I agree to wear a mask at all times. Initial: *

I agree to assess myself for symptoms of COVID-19 (recommended online assessment: https://landing.google.com/screener/covid19 ) prior to coming and I will not attend any event if I have symptoms. Initial: *

I understand that I am entering a public space at my own risk. Initial: *

I understand that I may be asked to show proof of vaccination before entering certain indoor events. I understand that if an event requires proof of vaccination, it will be noted on the specific event page at counterpulse.org. Inital: *

Prior to AND for two weeks following your visit to CounterPulse/CounterPulse performance area, if you, or anyone who joins you becomes aware that they or anyone they have had contact with someone with symptoms or a positive COVID-19 test, you agree to Contact CP staff immediately at info@counterpulse.org. Initial: *

CHOICE OF LAW: I understand and agree that the law of the State of California will apply to this contract. I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE.

Full printed name *

Date *

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

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