COVID-19 Assumption of Risk and Waiver of Liability for Sunday Worship

Date of Worship *

Which service are you attending?*

8:30 a.m.9:30 a.m.11:00 a.m.

Print Name of Participant or Parent/Guardian*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Number of people attending (including you)*

What are the names of other people attending, if any?*

Assumption of Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus/COVID-19 has been declared a worldwide pandemic by the World Health Organization. As a result, federal, state, and local governments and health agencies recommend health and safety precautions, including social distancing, wearing masks, and diligent hand-washing.

First Presbyterian Church of Atlanta (“FPC”) is committed to the health and safety to all who participate with us. FPC has put preventative measures in place to reduce the spread of COVID-19. However, FPC cannot guarantee that you or your children/family will not become infected with COVID-19 while participating in activities at FPC; attending activities at FPC could increase your risk and your children’s/family’s risk of contracting COVID-19. Participants are expected to take precautions for the preservation of their own and others’ health and safety.

With my signature below:

I affirm that the participants in my party (listed below) do not have, and in the past 14 days have not had a positive test for COVID-19 or COVID-19 symptoms (cough, shortness of breath, fever, chills, muscle pain, sore throat, new loss of taste or smell).
I affirm that the participants in my party have not knowingly had any close contact without use of personal protective equipment with someone with COVID-19 within the last 14 days.
I affirm that the participants in my party have not knowingly lived with someone with COVID-19 within the last 14 days.
I agree that the participants in my party will abide by FPC’s social distancing guidelines (maintaining 6 feet of separation from others while on FPC premises) and will follow directions for one-way movement inside the building.
I agree that the participants in my party (4 years and older) will wear a mask/face covering while on FPC premises, including in outdoor spaces.
I agree that the participants in my party will wash/sanitize our hands regularly and will refrain from handshakes, hugs, and other personal contact while on FPC premises.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my children/family and I may be exposed to or infected with COVID-19 while attending events at or sponsored by FPC, and that such exposure or infection may result in personal injury, illness, disability, and death. I understand that the risk of becoming exposed to or infected with COVID-19 at FPC events may result from the actions, omissions, or negligence of myself and others, including, but not limited to, FPC staff, volunteers, and other FPC participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my children/family or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my children/family may experience or incur in connection with attendance at FPC events (“Claims”). In exchange for the right to attend events at or sponsored by FPC, on my behalf, and on behalf of my children/family, I hereby release, covenant not to sue, discharge, and hold harmless First Presbyterian Church of Atlanta, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of FPC, its employees, volunteers, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any FPC event.

The Undersigned acknowledges that in choosing to sign this Agreement, he or she is not relying on any representations from FPC that are not specifically set forth herein. This Agreement shall be governed by the laws of the State of Georgia without application of Georgia’s choice of law rules.

Signature of Participant or Parent/Guardian *

Signature Confirmation*

I certify that I have signed above.

Date*

Date