22647 Ventura Blvd, #249, Woodland Hills, CA 91364

CORONAVIRUS / COVID-19 WARNING & DISCLAIMER Corona virus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing, testing for COVID-19 illness, wearing a mask and vaccination as a means to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in SFV-CAMFT programs could increase the risk of contracting COVID-19. SFV-CAMFT in no way guarantees that COVID-19 infection will not occur through participation in SFV-CAMFT programs.

In consideration of my participation in the any SFV-CAMFT events or programs, the undersigned acknowledges and agrees to the following:

• I am aware of the existence of risk if I appear in person and that my participation in any activity of SFV-CAMFT may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.
  
• I have not experienced symptoms of fever, fatigue, difficulty breathing, dry cough, or any other symptoms relating to COVID-19 or any communicable disease within the last 14 days.
• I have not, nor any member(s) of my household, traveled by sea or by air, internationally or within the United States during the past 14 days.
• I have not been, nor have any member(s) of my household, diagnosed to be infected of COVID-19 virus within the last 30 days.

Following the pronouncements above I hereby declare the following:

• I am fully and personally responsible for my own safety and actions while and during my participation at SFV-CAMFT events and programs, and I recognize that I may be at risk of contracting COVID-19.
• With full knowledge of the risks involved, I hereby release, waive, discharge SFV-CAMFT, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.
• I agree to indemnify, defend, and hold harmless the SFV-CAMFT  from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.
• I understand that I can spread the virus if exposed to it. I will take precautions to social distance and wear a mask, and am aware of the risks others may have if I fail to social distance and wear a mask.

COVID-19 Assumption of Risk

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 it 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. I acknowledge that while SFV-CAMFT is committed to following protocols set forth by the State of California Public Health Officer and Director of California Public Health, I understand that an inherent risk of exposure to COVID-19 exists in any public place where people are present.  I voluntarily assume all risks related to exposure to COVID-19 and agree to not hold SFV-CAMFT or any of its affiliates, directors, officers, employees, agents, contractors, or volunteers liable for illness or injury.

This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted. 

Full Name: ________________        Phone Number: ____________

Signature: _________________    Date: _____________