I agree to the release of liability and hold harmless the USC-DC from and against any and all costs, expenses, damages, lawsuits, liabilities, or claims arising from or related to any claims made by or against any of the released parties due to injury, loss, or death from or related to COVID-19.
I agree that in the event that I suspect I became exposed to or infected by COVID-19 at the USC-DC Annual Session and I elect to seek testing and/or treatment as a result therefrom, I will be responsible for payment of any and all medical treatment and testing services.
By signing below, I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; that I have been sufficiently informed of the risks involved and give my voluntary consent in signing this document as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation. This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted. EVEN IF ARISING FROM THE NEGLIGENCE, ACTS, OR OMISSIONS OF THE RELEASED PARTIES. I HAVE READ AND UNDERSTAND THIS AGREEMENT, AND I AM AWARE THAT BY SIGNING BELOW, I MAY BE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.
*Required information
Name *
First Name
Last Name
Consistory/Assembly * :
Orient * :
Phone Number * :
(000) 000-0000
Email * :
example@example.com
Signature *
Date Signed *
MM-DD-YYYY
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