COVID-19 Liability Release Waiver

Shasta Baptist Church is doing our part to maintain, clean, and sanitize our facilities and vehicles. We are also doing our best to mitigate the transmission of covid-19 by recommending masks to be worn and social distancing to be followed.
Shasta Baptist Church Bus Rider Permission Form

COVID-19 Liability Release Waiver
In consideration of my participation in the foregoing, the undersigned acknowledge and agree to the following:

I or my child(ren) have not experienced symptoms that of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 14 days.I have not been, nor any member(s) of my household, diagnosed to be infected of COVID-19 virus within the last 30 days.
By signing below 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.
Name

First NameLast Name
Phone Number*
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Children riding the bus.*

First NameLast Name
Children riding the bus.

First NameLast Name
Children riding the bus.

First NameLast Name
Children riding the bus.

First NameLast Name
Signature

Clear
Date Signed

MonthDayYear
Date
Should be Empty:

Shasta Baptist Church Bus Rider Permission Form