Waiver
Release of Liability, Waiver of all Possible Claims and Assumption of Risks and Attestation for Self-Reporting
I hereby acknowledge that I have agreed to attend in person at Community Family Services of Ontario (CFSO), for the purpose of receiving services provided by CFSO.
I acknowledge and accept that there is a risk that I could be exposed to infections such as COVID-19 while attending CFSO. I also acknowledge and accept that while receiving services, CFSO may need to be closer than the recommended social distancing guidelines to assess and/or treat me. I understand that CFSO has informed procedures in place for infection control and public health reporting. I acknowledge and confirm that I am willing to accept this risk as a condition of attending CFSO to receive services.
In consideration of the CFSO agreeing to see me in person at CFSO, I agree to release the CFSO, their officers, directors, employees, agents, students, externs, volunteers, and funders (the “Releasees”) from any and all causes of action, claims, demands, requests, damages or any recourse whatsoever in respect of any personal injuries or other damages which may occur or arise as a result of exposure to infection during my visit to CFSO and/or through the provision of services to me by the CFSO.
I do hereby acknowledge and agree that notwithstanding the generality of the foregoing, I declare that I will not commence litigation or otherwise seek to recover damages or other compensation against the Releasees based on any action, claim, demand, request, loss, or any recourse whatsoever arising from any potential or actual exposure to infections including COVID-19 while attending at CFSO and/or through the provision of services to me by CFSO.
I further acknowledge that the Releasees can rely on this Release of Liability, Waiver of all Possible Claims, and Assumption of Risk as a complete defense to any and all claims, damages, causes of action, or recourse or liability that may arise at any time.
I attest that I have truthfully and wholesomely declared all current and related symptoms, infections, and exposure history of me and all members attending services with me, to the best of my knowledge, to CFSO representatives before the start of in-person services. I understand that CFSO staff may contact me after my services for reasons required by Public Health in relation to infections and/or contact tracing.
I have carefully reviewed this Release of Liability, Waiver of all Possible Claims and Assumption of Risk and acknowledge that I fully understand the terms as set out above. I acknowledge that I am signing this Release of Liability, Waiver of all Possible Claims, and Assumption of Risk voluntarily.
By checking off the box, you agree and consent to the statement of the waiver