YM - Volunteer COVID Waiver

You are being asked to complete this Permission Waiver because because the signup or application you completed did not include this or we simply do not have one on file for you.

EVENT NAME & DATE

Please note the Youth Ministry event and date you are signed up for in the box below.
*
VOLUNTEER Information
Name Name * First Last
Birth Date Birth Date * / MM / DD YYYY
PRINT and HARD SIGNATURE

Read each section and choose the "YES" box underneath each. ADD your signature at the end and then press "Continue" below.

Please PRINT the confirmation/review page and sign it by next to the electronic signature. The signed document must be submitted to the Parish office. Make sure you still hit "Submit" to complete the online process.
AWARENESS OF RISK
The novel coronavirus, COVID-19, has been declared a worldwide pandemic and is contagious. As a result, in order to resume Youth Ministry and CYO sports activities (“Youth Ministry”), the Catholic Diocese of Arlington has established essential health and safety measures at the Catholic parish named above ("Parish"). The Parish has put in place reasonable preventative measures and standards of behavior, consistent with guidelines issue by the Centers for Disease Control and prevention (“CDC”) and state and local public health guidance, to reduce the spread of COVID-19 in Parish and Youth Ministry activities. Even with implementation of health and safety protocols, however, the Diocese and Parish cannot guarantee that you will not become infected with COVID-19, and participation in Parish or Youth Ministry activities could increase your risk of contracting COVID-19. Any interaction with others includes possible exposure to, and illness from, communicable diseases including COVID-19 and influenza. I willingly agree that I will comply with the health and safety protocols established by Parish, and will take all reasonable and necessary additional precautions to protect against communicable diseases while on Parish premises, not only for my own benefit but for the benefit of others with whom I may come into contact. I agree that, if I observe any objects, practices or procedures I believe to be hazardous while on Parish premises, I will remove myself from the location of such hazard and bring it to the attention of Parish administration immediately.
I have read the awareness of risk. *

I have read the awareness of risk. Yes.
LIABILITY WAIVER
By signing this agreement, I acknowledge the contagious nature of COVID-19 and that I may be exposed to or infected by COVID-19 by participating in in-person Youth Ministry activities, and that such exposure or infection may result in personal injury, illness, permanent disability, and/or death. I understand that the risk of becoming exposed to or infected by COVID-19 at the above-named Parish may result from the actions, omissions, or negligence of myself, or others, including, but not limited to Diocesan or Parish administrators, employees, volunteers, and other program participants and their families. I further agree on behalf of myself and my respective heirs, successors, and assigns, to fully and forever release, defend, indemnify, and hold harmless the Catholic Diocese of Arlington, the named Parish, their clergy, administrators, employees, agents, members and volunteers ("Indemnitees") from any and all claims, damages, demands, and causes of action, present or future, known or unknown, anticipated or unanticipated, in any way related to exposure to COVID-19 while participating in Youth Ministry activities, including but not limited to any claims of negligent exposure. This includes claims that arise from my own and others’ acts, actions, activities and/or omissions, excepting only those which arise solely from the gross negligence, recklessness or intentional torts of Indemnitees. I will defend and indemnify Indemnitees with respect to any released claim, including but not limited to damages, costs and attorney’s fees.
I have read the liability waiver. *

I have read the liability waiver. Yes.
RESPONSIBILITY FOR HEALTH SCREENING
By execution of this Statement, I affirm that my presence at the Parish or participation in Youth Ministry activities on any day constitutes an affirmative representation on my part that that I have performed the health screening below and affirm that the responses to all questions are NO. SCREENING QUESTIONS “YES or NO, I do not have any of the following:” • A fever of 100.4°F (38°C) or higher or a sense of having a fever during the past 72 hours • New or unexpected cough that cannot be attributed to another health condition • New shortness of breath or difficulty breathing that cannot be attributed to another health condition • New chills that cannot be attributed to another health condition • A new sore throat that cannot be attributed to another health condition • New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise) • New loss of taste or smell • Nausea, vomiting or diarrhea • Cared for or had other close contact with a person suspected or confirmed to have COVID-19 • Travelled internationally • Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19 “YES or NO, in the past 14 days, I have not done any of the following:” I understand that on any day when I or anyone in my household has any of the above symptoms or situations, I am not permitted to participate in Youth Ministry activities.
I have read the responsibility for health screening. *

I have read the responsibility for health screening. Yes.
NEED TO INFORM & QUARANTINE
I hereby authorize the Parish to enforce such other reasonable measures and directives as may be deemed necessary by the Bishop of the Diocese of Arlington, its Office of Youth, Campus, and Young Adult Ministries, or the Pastor or Youth Ministry staff of the Parish. This Agreement has been prepared in the English language, and the English version thereof shall prevail and be binding in the event of any inconsistency even though a Spanish or other language translation may also be prepared. By execution of this Statement, I understand and agree to the foregoing terms and conditions.
I have read the terms to inform and quarantine. *

I have read the terms to inform and quarantine. Yes.
AUTHORIZATION & INFORMED CONSENT
I hereby authorize the Parish to enforce such other reasonable measures and directives as may be deemed necessary by the Bishop of the Diocese of Arlington, its Office of Youth, Campus, and Young Adult Ministries or the Parish leadership. I further understand that, in the event that it becomes necessary that events or programs should be cancelled or administered via electronic media, I will not be entitled to a refund of any of my fees. This Agreement has been prepared in the English language, and the English version thereof shall prevail and be binding in the event of any inconsistency even though a Spanish or other language translation may also be prepared. By execution of this Agreement, I understand and agree to the foregoing terms and conditions.
Sign in the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

YM - Volunteer COVID Waiver

YM - Volunteer COVID Waiver

EVENT NAME & DATE

VOLUNTEER Information

PRINT and HARD SIGNATURE