to participate in all activities and any field trips of the STARS Summer Enrichment Program. I, the undersigned, agree to hold harmless the Center for the Visually Impaired, its employees, volunteers and other agents involved, from any and all injury or liability of any nature. In case of emergency, if I cannot be directly reached, I give permission for an emergency contact or Center for the Visually Impaired to sign any necessary emergency medical treatment forms in my absence.
Department of Family and Children Services Release
STARS (Social, Therapeutic, Academic and Recreational Services) is an educational, recreational, and social skills program for youth ages 5-21 who are blind or visually impaired. In the STARS Summer Enrichment Program, elementary, middle, and high school campers attend weekly sessions with same-aged peers.
I hereby acknowledge that I have been advised and understand that the program my child is participating in at the Center for the Visually Impaired, STARS Summer Enrichment, is neither licensed nor required to be licensed by the Georgia Department of Early Care and Learning.
ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19
COVID-19 IS EXTREMELY CONTAGIOUS and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend hygiene practices including use of masks and social distancing.
The Center for the Visually Impaired, Inc. (“CVI”) offers programs and services for the visually impaired directly or through tenants and subcontractors at its facilities located at 739 W Peachtree St NW, Atlanta, GA 30308 (the “CVI Facilities”). CVI has put in place preventative measures to reduce the risk of the spread of COVID-19 at the CVI Facilities. The measures apply to services and programs offered at the CVI Facilities directly by CVI and by its tenants and subcontractors.
By signing this agreement, I agree that I and my child(ren) will comply fully with such preventative measures. However, I acknowledge that CVI cannot guarantee that I or my child(ren) will not become infected with COVID-19 when we enter the CVI Facilities for any purpose, and that visiting the CVI Facilities and participating in the programs and services offered could increase my and my child(ren)’s risk of contracting COVID-19.
By signing this agreement, I acknowledge the extremely contagious nature of COVID-19 and voluntarily assume the risk that I and/or my child(ren) may be exposed to or infected by COVID-19 by visiting the CVI Facilities or by participating in the programs and services offered, and that such exposure or infection may result in personal or bodily injury, illness, temporary or permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 either by entering the CVI Facilities or by participating in the programs and services offered there may result from the actions, omissions, or negligence of myself and/or others, including, but not limited to, CVI or its agents, employees, representatives, volunteers, subcontractors or tenants (collectively, “CVI Parties”) or by program and service participants and/or their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my myself and/or my child(ren) (including, but not limited to, personal or bodily injury, illness, temporary or permanent disability, and death), damage, loss, claim, liability, or expense, of any kind, that I and/or my child(ren) may experience or incur in connection with my and/or my child(ren)’s entering the CVI Facilities or by participating in programs and services offered there, whether offered directly by CVI or by tenant or subcontractor of CVI (collectively, the “Claims”).
On my behalf, and on behalf of my children, I hereby release and indemnify the CVI Parties, and each of them, from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto, and covenant not to sue the CVI Parties, or any of them, for any Claims. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the CVI Parties, or any of them, whether a COVID-19 infection occurs before, during, or after my entering the CVI Facilities for any purpose whatsoever.
I further represent that I and my child(ren) are feeling well today and that neither I nor my child(ren) have contracted COVID-19 or have any other flu-like symptoms including a cough, nasal congestion, loss of smell or loss of taste.