COVID-19 Screening and Release Form

COVID-19 Screening and Release Form

Health Screening and Release of Liability and Assumption of Risk
Chamber Music | OC requires all individuals appearing in person at its premises or otherwise participating in any event affiliated with Chamber Music | OC to complete and submit this form no earlier than 24 hours prior to their arrival. If you are scheduled to appear in person, you may receive a courtesy reminder in advance. A new form must be completed and submitted for every appearance. There are no exceptions to this requirement.

Open to read full Release
Release of Liability and Assumption of Risk

The individual named below (referred to as "I" or "me") desires to enter the premises of CHAMBER MUSIC | OC (“CMOC”), a California Nonprofit (the "Company") located at 23666 Birtcher Drive, Lake Forest, CA 92630 (the "Premises") to engage in performing arts, or any other activity (the "Activity"). In consideration of being permitted by the Company to be on the Premises and engage in the Activity and in recognition of the Company's reliance hereon, I agree to all the terms and conditions set forth in this agreement (this "Release").

1. I am aware of the highly contagious nature of bacterial and viral diseases including the 2019 novel coronavirus disease (COVID-19) (collectively, the "Disease") and the risk that I may be exposed to or contract the Disease by being on the Premises and engaging in the Activity. I understand and acknowledge that such exposure or infection may result in serious illness, personal injury, permanent disability, death, and/or property damage. I acknowledge that this risk may result from or be compounded by the actions, omissions, or negligence of others, including Company employees. I understand that while the Company has implemented preventative measures designed to reduce the spread of the Disease, the Company cannot guarantee that I will not become infected with the Disease while on the Premises and that being on the Premises may increase my risk of contracting the Disease. NOTWITHSTANDING THE RISKS ASSOCIATED WITH THE DISEASE, I ACKNOWLEDGE THAT I AM VOLUNTARILY ENTERING THE PREMISES TO ENGAGE IN THE ACTIVITY WITH KNOWLEDGE OF THE DANGER INVOLVED. I HEREBY AGREE TO ACCEPT AND ASSUME ALL RISKS OF PERSONAL INJURY, ILLNESS, DISABILITY, DEATH, AND/OR PROPERTY DAMAGE RELATED TO THE DISEASE, ARISING FROM MY BEING ON THE PREMISES OR ENGAGING IN THE ACTIVITY, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE COMPANY OR OTHERWISE.

2. I hereby expressly waive and release any and all claims, now known or hereafter known, against the Company, and its officers, directors, employees, agents, affiliates, shareholders/members, successors, and assigns (collectively, "Releasees"), on account of injury, illness, disability, death, or property damage arising out of or attributable to my being on the Premises or engaging in the Activity and being exposed to or contracting the Disease, whether arising out of the ordinary negligence of the Company or any Releasees or otherwise. I covenant not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims. This waiver and release does not extend to claims for gross negligence, willful misconduct, or any other liabilities that California law does not permit to be released by agreement.

I understand that by signing this release, I am waiving any and all claims of any kind arising out of or attributable to my being on the Premises or engaging in the Activity and being exposed to or contracting the Disease, including those claims that may be unknown to me, or which I do not suspect to exist at this time. WITH THE INTENTION OF WAIVING ALL UNKNOWN AND UNSUSPECTED CLAIMS, I HEREBY EXPRESSLY WAIVE ALL RIGHTS, BENEFITS, AND PROTECTIONS I MAY HAVE UNDER CALIFORNIA CIVIL CODE SECTION 1542, WHICH READS AS FOLLOWS:

A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.

3. I am familiar with federal, state, and local laws, orders, directives, and guidelines related to the Disease, including the Centers for Disease Control and Prevention (CDC) guidance on the Disease. I will comply with all such orders, directives, and guidelines while on the Premises, including, without limitation, requirements related to hand sanitation, social distancing, and use of face coverings. I will also follow all instructions of the Company while on the Premises. I agree not to enter the Premises if I am experiencing symptoms of the Disease (such as cough, shortness of breath, or fever), have a confirmed or suspected case of the Disease, or have come in contact in the last ten (10) days with a person who has been confirmed to have or suspected of having the Disease.

4. I shall defend, indemnify, and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorney fees, fees, the costs of enforcing any right to indemnification under this Release, and the cost of pursuing any insurance providers, incurred by/awarded against the Company or any other Releasees in a final judgment, arising out or resulting from any claim of a third party related to the Disease due to my engaging in the Activity or being on the Premises, including any claim related to my own negligence or the ordinary negligence of the Company.

5. This Release constitutes the sole and entire agreement of the Company and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Release is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction. This Release is binding on and shall inure to the benefit of the Company and me and our respective successors and assigns. All matters arising out of or relating to this Release shall be governed by and construed in accordance with the internal laws of the State of California without giving effect to any choice or conflict of law provision or rule. Any claim or cause of action arising under this Release may be brought only in the federal and state courts located in Orange County, California and I hereby consent to the exclusive jurisdiction of such courts.

BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS RELEASE AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY.

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I, the undersigned, hereby acknowledge and agree to the following:*

I have read and understand all of the terms of the above Release and that I am voluntarily giving up substantial legal rights, including the right to sue the Company.I have not, nor anyone to whom I have had known exposure, experienced a fever, fatigue, difficulty breathing, diarrhea, vomiting, chest congestion, sudden loss of taste or smell, dry cough, or any other symptoms relating to COVID-19 or any communicable disease within the last 14 days.I am not, nor anyone to whom I have had known exposure, currently under isolation or quarantine orders.I have not, nor anyone to whom I have had known exposure, traveled internationally within the past 30 days.I have not, nor anyone to whom I have had known exposure, traveled to any any area within the United States that was reported to be highly affected by COVID-19, within the last 30 days .I have not, nor anyone to whom I have had known exposure, been diagnosed with COVID-19 within the last 30 days.
In the event that undersigned is under the age of 18, the signature of a parent or guardian is required.*

I am 18 years of age or older.I am under the age of 18.
Name of Parent/Guardian*

First NameLast Name
Signature of Parent/Guardian*

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I am the parent or legal guardian of the minor named below. I have the legal right to consent and, by signing below, I hereby do consent to the terms and conditions of this Release.
Name*

First NameLast Name
Phone Number*
Email*
Date

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Signature*

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