Page 14 - 2021GradeSchoolCamps

Parent Permission and COVID Waiver of Liability for
PARENT PERMISSION AND COVID WAIVER OF LIABILITY FOR
Student Participation at Cor Jesu Academy
STUDENT PARTICIPATION AT COR JESU ACADEMY
PARENT PERMISSION AND COVID WAIVER OF LIABILITY FOR
STUDENT PARTICIPATION AT COR JESU ACADEMY
By signing below, I give permission for my child, _____________________________, to participate in a
2021 summer camp at Cor Jesu Academy.
By signing below, I give permission for my child, _____________________________, to participate in a

2021 summer camp at Cor Jesu Academy.

I acknowledge that federal and state government officials have declared that

(initials) there currently exists a public health crisis in our country related to the

I acknowledge that federal and state government officials have declared that
there currently exists a public health crisis in our country related to the
(initials) Coronavirus Disease 2019 (“COVID-19”).

I confirm that I will not permit my child to participate in the program or activity if,
Coronavirus Disease 2019 (“COVID-19”).
(initials) at any time during the program or activity, my child is showing any symptoms of
I confirm that I will not permit my child to participate in the program or activity if,
COVID-19 (including but not limited to fever, dry cough, fatigue, shortness of
(initials) at any time during the program or activity, my child is showing any symptoms of
breath, chills, muscle pains). Additionally, I confirm that I will not permit my child
COVID-19 (including but not limited to fever, dry cough, fatigue, shortness of
to participate in the program or activity if, at any time during the program or
breath, chills, muscle pains). Additionally, I confirm that I will not permit my child
activity, my child has been in contact with any individual diagnosed with COVID-
to participate in the program or activity if, at any time during the program or
19 or any individual currently waiting for test results confirming the possibility of
activity, my child has been in contact with any individual diagnosed with COVID-
a COVID-19 diagnosis. I agree that in such situations, my child will be unable to
19 or any individual currently waiting for test results confirming the possibility of
participate in the program or activity until: (i) 14 calendar days after the
a COVID-19 diagnosis. I agree that in such situations, my child will be unable to
symptoms first appeared and my child is no longer showing any symptoms; or (ii)
participate in the program or activity until: (i) 14 calendar days after the
a healthcare provider has confirmed in writing that my child has tested negative
symptoms first appeared and my child is no longer showing any symptoms; or (ii)
for COVID-19 or that my child’s symptoms were not due to COVID-19.
a healthcare provider has confirmed in writing that my child has tested negative

for COVID-19 or that my child’s symptoms were not due to COVID-19.
I understand that Cor Jesu Academy cannot prevent the possible transmission or
(initials) contraction of COVID-19 for my child.
I understand that Cor Jesu Academy cannot prevent the possible transmission or
contraction of COVID-19 for my child.
(initials)
The undersigned agrees to release, discharge, hold harmless and indemnify Cor Jesu Academy, its
agents, employees, officers, Board of Directors, insurers and others acting on the school’s behalf (the
The undersigned agrees to release, discharge, hold harmless and indemnify Cor Jesu Academy, its
“Releasees”), of and from any and all claims, demands, causes of action and/or legal liabilities for
agents, employees, officers, Board of Directors, insurers and others acting on the school’s behalf (the
injuries to or death of my child occurring during, or resulting from, or participation in the above-
“Releasees”), of and from any and all claims, demands, causes of action and/or legal liabilities for
mentioned program or activity and related in any way to COVID-19, even if the cause, damages or
injuries to or death of my child occurring during, or resulting from, or participation in the above-
injuries are alleged to be the fault of or alleged to be caused by the negligence or carelessness of the
mentioned program or activity and related in any way to COVID-19, even if the cause, damages or
Releasees.
injuries are alleged to be the fault of or alleged to be caused by the negligence or carelessness of the

Releasees.

Student’s Name _________________________________________________

Student’s Name _________________________________________________

Signature: _________________________________________________
(Parent or Legal Guardian)
Signature: _________________________________________________

(Parent or Legal Guardian)

Date: _____________________________________________________

Date: _____________________________________________________
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