ROCK : COVID-19 CONSENT FORM AND LIABILITY WAIVER

ARCHDIOCESE OF NEW ORLEANS PARENTAL/GUARDIAN COVID-19 CONSENT FORM AND LIABILITY WAIVER
June 1, 2020 - August 31, 2021

We will do our best to follow COVID guidelines, however if you are immunocompromised, live with those that are or if you have any concerns if you should come in contact with COVID, please consider the risks before attending events.

Participant’s First Name:
Participant’s Last Name:
Date of Birth:
Sex:
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Business Phone Business Phone - ### - ### ####
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health
Organization. COVID-19 is extremely contagious and as a result, social distancing is recommended.

St. Peter Parish/School will follow state and local standards of conduct and has put in place reasonable preventative measures to reduce the spread of COVID-19 at its Parish/School
activity (including but not limited to summer camp). However, even though such standards will be followed and reasonable measures put into place, Parish/School cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Parish/School activity could increase your risk and your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and that my child(ren) and I may be exposed to or infected by COVID-19 by participating in the parish/school activity 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 St. Peter Parish/School may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Parish/School employees, volunteers, and program
participants and their families. Considering the foregoing, however, I
Parents/Guardian's Name: Parents/Guardian's Name: First Last
grant permission for my child,
Child's Name: Child's Name: First Last
to participate in this parish activity that may require transportation to a location away from the parish site, notwithstanding the risks associated with the COVID-19 virus and group activities.

I confirm that there are no necessary changes to the Medical Information Consent form for my child that I previously submitted. If there are any necessary changes, I will complete another Medical Information Consent form.

I further agree on behalf of myself, my child named herein, and my spouse, our heirs, successors, and assigns, to release, indemnify, hold harmless, and defend St. Peter Parish/School and The Roman Catholic Church of the Archdiocese of New Orleans, their members, directors, officers, employees, agents and representatives (“indemnitees”) associated with the event arising from or in connection with the negligent acts or omissions of the indemnitees’ in relation to prevention of the spread of the COVID-19 virus.

I SPECIFICALLY ACKNOWLEDGE AND AGREE THAT I AM AGREEING TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE INDEMNITEES’ FROM THEIR OWN NEGLIGENCE IN REGARD TO THE INDEMNITEES’ NEGLIGENT ACTION AND/OR INACTION IN REGARD TOPROTECTION AGAINST THE COVID-19 VIRUS.
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Date Date / MM / DD YYYY

ROCK : COVID-19 CONSENT FORM AND LIABILITY WAIVER

ROCK : COVID-19 CONSENT FORM AND LIABILITY WAIVER

grant permission for my child,