• Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • ASSUMPTION OF RISK AND WAIVER OF LIABILITY RELATED TO COVID-19

    Thank you for participating in our Zumbro Valley Health Center programs. We know you have alternatives, and we thank you for choosing to work with us at this time. These are not normal times. 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 from person-to-person contact, including through respiratory droplets, and in other ways that the Centers for Disease Control and Prevention is still learning. Community-spread COVID-19 is prevalent in Minnesota and new cases are occurring frequently. As a result, federal, state, and local governments and various health agencies recommend physical distancing and have, at certain times and locations, prohibited groups of people congregating. ZVHC has put in place preventative measures to reduce the spread of COVID-19, and we need everyone’s help in following our guidelines. Our guidelines are available for your review, and can be found on our website. Given an extremely contagious virus and pandemic, Zumbro Valley Health Center cannot guarantee that participants in our program will avoid becoming exposed to and infected by COVID-19. Further, attending our program could increase the risk of contracting COVID-19.
  • Assumption of Risk

    By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that the undersigned participant/child/parent/guardian may be exposed to or infected by COVID-19 by attending this program. I understand that such exposure or infection may be very serious and result in personal injury, illness, disability, and even death. It is my choice to participate in this program, and/or to send my participant to this program, knowing that attending this program may increase the risk of becoming exposed to and infected by COVID-19. I understand and appreciate the risk of becoming exposed to and infected by COVID-19 as part of attending the program. I acknowledge that exposure to COVID-19, injury, illness, disability, and even death may result from the actions, omissions, or negligence of myself and others, or the actions, omissions or negligence of Zumbro Valley Health Center including but not limited to its management, employees, and volunteers, or the fault of program participants and their families. I voluntarily agree to assume all of the risks outlined in this form including contracting COVID-19, and the undersigned accepts sole responsibility for any injury or illness to the participant or myself. This risk includes illness, injury, disability and death, and all associated losses and expenses of any kind that I or the participant may experience or incur.
  • Waiver

    In consideration of being permitted to participate in the list, organization, and/or program/activity I, for myself, and on behalf of the participant, hereby release, agree not to sue, discharge, and hold harmless, Zumbro Valley Health Center, its officers, employees, agents, and representatives, from all claims, actions, damages, costs or expenses of any kind relating to COVID-19. I understand and agree that this release includes any and all claims based on the actions, omissions, or negligence of Zumbro Valley Health Center, its officers, employees, agents, or representatives.
  • Indemnification and Hold Harmless

    I also agree to indemnify, defend, and hold harmless Zumbro Valley Health Center and its officers, employees, agents and representatives from any and all claims, actions, costs, expenses, damages and liabilities, including attorney’s fees, relating to any claim of exposure, infection, injury or illness concerning COVID-19 arising from participation in the listed program or activity.