Novel Coronavirus Acknowledgement & Assumption of Risk
St. Michael's and St. Mary's Catholic Churches
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Family Last Name *
I acknowledge and understand, the novel coronavirus, COVID-19 has been declared a worldwide pandemic by the World Health Organization. Further, that COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. I also acknowledge, that federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited or limited the congregation of groups of people.

I agree, represent and warrant that neither the undersigned, nor any registered participant child(ren) shall visit or utilize the facilities, programs, activities, or services of St. Michael’s and St. Mary’s Catholic Churches within 14 days after (1) returning from outside the United States, (2) exposure to any person returning from outside the United States, or (3) exposure to any person who has a suspected or confirmed case of COVID-19.

I hereby agree, represent and warrant that neither the undersigned nor any registered participant child(ren) shall visit or utilize the facilities, programs, activities, or services of St. Michael’s and St. Mary’s Catholic Churches if he or she (1) experiences symptoms of COVID-19, including, without limitation, fever, cough or shortness of breath, or (2) has suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify St. Michael’s and St. Mary’s Catholic Churches immediately if any of the foregoing access or use restrictions may apply.

St. Michael’s and St. Mary’s Catholic Churches has put in place preventative measures to reduce the spread of COVID-19. I agree to comply with measures that St. Michael’s and St. Mary’s Catholic Churches may require to best protect against the introduction of viruses at St. Michael’s and St. Mary’s Catholic Churches, including, but not limited to, hygiene practices and temperature screening, related to myself and/or my child(ren). St. Michael’s and St. Mary’s Catholic Churches cannot guarantee that my child(ren) will not become infected with COVID-19. I understand and agree that attending St. Michael’s and St. Mary’s Catholic Churches could increase my risk and my child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by participating in programs of or attending St. Michael’s and St. Mary’s Catholic Churches 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 St. Michael’s and St. Mary’s Catholic Churches may result from the actions, omissions, or negligence of myself and others, including, but not limited to, St. Michael’s and St. Mary’s Catholic Churches employees, volunteers, and program participants and their families.
Digital Signature - By typing my signature below, I acknowledge and agree this electronic signature is the legally binding equivalent to my handwritten signature. This electronic signature has the same validity and meaning as my handwritten signature. By typing my signature below as adult/parent/guardian, I acknowledge and agree to the conditions above. *
Second Adult in Household Digital Signature - By typing my signature below, I acknowledge and agree this electronic signature is the legally binding equivalent to my handwritten signature. This electronic signature has the same validity and meaning as my handwritten signature. By typing my signature below as adult/parent/guardian, I acknowledge and agree to the conditions above. *
Second Adult in Household Email Address
Child(ren) Full Name(s) - Include all children that will be participating in on-site programs - separate by a comma.
A copy of your responses will be emailed to the address you provided.
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