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COVID Waiver of Liability Form
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus (“COVID-19”) has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. Justin Hagen and Kyokushin Philly have put in place preventative measures to reduce the spread of COVID-19; however, cannot guarantee that you will not become infected with COVID-19. Further, attending any program or activity under the direction of Justin Hagen and any of the locations where class are held including, but not limited to, XL Sports, BucksMont TKD and other locations, could increase your risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 while on location and during classes and events under the direction of Justin Hagen and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at XL Sports and other locations may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Justin Hagen, XL Sports, BucksMont TKD and other locations' employees, volunteers, and program participants and their families.
I further understand that in engaging in martial arts activities and events it will not be possible to maintain 6 feet of distance between myself and others. Furthermore, I understand that masks are optional and that participants, spectators, coaches and instructors may not be wearing masks throughout and during martial arts events and training. I further understand that vaccination status is confidential and is not required to be disclosed and that COVID tests are also not required. As such, I recognize and accept that participants, spectators, coaches and instructors may not be vaccinated nor have a negative COVID test and will hold none but myself liable should I contract COVID or other infectious illnesses.
If I feel uncomfortable with others removing masks or breaking social distancing guidelines, I understand that I hold sole responsibility only for myself and am not responsible for the doings of others and am free to leave the training or event at any time.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at XL Sports, and other training and event locations may result from the actions or (“Claims”). On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless Justin Hagen, XL Sports, BucksMont TKD and other indoor/outdoor locations and their employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto.
I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Justin Hagen, XL Sports, BucksMont TKD and other indoor/outdoor locations their employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after attending any martial arts, fitness or Kyokushin Philly related program or activity.
___________________________________ _____________________________________________ Participant’s Signature & Date Participant’s Printed Name & Age (Please print legibly)
PARENTAL CONSENT (If participant is under 18 Years Old):
___________________________________ _____________________________________________ Parent/Guardian Signature & Date Printed Name of Parent/Guardian
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