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COVID - Assumption of Risk and Waiver of Liability Non-Members

This form is for non-members only.

If you are a member of Temple Beth Shalom, use the members-only 
Assumption of Risk and Waiver of Liability form.
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
for Temple Beth Shalom

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, but not solely, from person-to-person contact. As a result, federal, state and local governments and federal and state health agencies recommend social distancing and have, in some locations, prohibited the congregation of groups of people.

Temple Beth Shalom has put in place preventative measures in an attempt to reduce the spread of COVID-19; however, Temple Beth Shalom cannot guarantee that you and/or your child(ren)and/or your family will not become infected with COVID-19. Further, attending Temple Beth Shalom activities or events related to Temple Beth Shalom, including without limitation: religious services, educational programs, Temple Beth Shalom Religious School, and/or any other activity or event, whether the same take place on or off Temple Beth Shalom premises (“Temple Beth Shalom programs”), could increase the risk of you and/or your child(ren) and/or family contracting COVID-19.

By signing this Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 (“Waiver”), I, for myself, and on behalf of my child(ren) and/or family, acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that by my child(ren) and/or family attending Temple Beth Shalom Programs, I and/or my child(ren) and/or family  may be exposed to and infected by COVID-19, 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 Temple Beth Shalom may result from the actions, omissions,  negligence, or gross negligence of me, my child(ren) and/or family and others, including, but not limited to, Temple Beth Shalom employees, volunteers, and Temple Beth Shalom Program participants and their families.  

I, FOR MYSELF, AND ON BEHALF OF MY CHILD(REN) AND FAMILY VOLUNTARILY AGREE TO ASSUME ALL OF THE FOREGOING RISKS AND ACCEPT SOLE RESPONSIBILITY FOR ANY INJURY TO ME AND MY CHILD(REN) AND FAMILY (INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURY, DISABILITY, AND DEATH), ILLNESS, DAMAGE, LOSS, CLAIM, LIABILITY, OR EXPENSE, OF ANY KIND, THAT I OR MY CHILD(REN) OR FAMILY MAY EXPERIENCE OR INCUR IN CONNECTION WITH MY CHILD(REN)’S OR FAMILY’S ATTENDANCE AT TEMPLE BETH SHALOM PROGRAMS (“CLAIMS”), HOWEVER CAUSED AND WHETHER CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OR GROSS NEGLIGENCE OF THE RELEASED PARTIES (AS HEREAFTER DEFINED).

I, FOR MYSELF, AND ON BEHALF OF MY CHILD(REN) AND FAMILY, HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, AND HOLD HARMLESS TEMPLE BETH SHALOM, ITS TRUSTEES, DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS, AGENTS, AND REPRESENTATIVES (“RELEASED PARTIES”), FROM THE CLAIMS, INCLUDING ALL LIABILITIES, CLAIMS, ACTIONS, DAMAGES, CAUSES OF ACTION, COSTS OR EXPENSES OF ANY KIND ARISING OUT OF OR RELATING THERETO, HOWEVER CAUSED AND WHETHER CAUSED IN WHOLE IN PART BY THE NEGLIGENCE OR GROSS NEGLIGENCE OF THE RELEASED PARTIES, AND WHETHER A COVID-19 INFECTION OCCURS BEFORE, DURING, OR AFTER PARTICIPATION IN ANY TEMPLE BETH SHALOM PROGRAMS.

By my signature below, I agree, acknowledge and consent that this Waiver is fully enforceable, and is binding upon me and my child(ren)’s legal representatives, family, heirs, administrators, guardians, executors, successors and assigns.  This Waiver is irrevocable and is binding immediately upon execution and cannot be modified, amended or limited unless agreed upon in writing by me and TEMPLE BETH SHALOM.  In the event any provision or part of this Waiver is found to be invalid or unenforceable, only that particular provision or part so found, and not the entire Agreement, will be inoperative.

By executing this Waiver, I further affirm that to the best of my knowledge (i) that neither I nor any Participant listed below currently has COVID-19, has tested positive for COVID-19 and not been told by a licensed medical doctor that he or she no longer pose a risk of infecting others, or has had COVID-19 like symptoms within the fourteen (14) days immediately preceding date of my execution of this instrument, and (ii) that neither I nor any Participant listed below has been in the presence of any person who we knew or had reason to believe at the time of such encounter had COVID-19, had tested positive for COVID-19 within such fourteen (14) day period, or who evidenced COVID-19 like symptoms within 2 such fourteen (14) day period. Neither I nor any Participant listed below will attend any TEMPLE BETH SHALOM Program if I or any Participant listed below on the day of such Program have COVID-19, have prior thereto tested positive for COVID-19 and have not been told by a licensed medical doctor that I or such Participant no longer pose a risk of infecting others, or I or any such Participant have had COVID-19 symptoms within fourteen (14) days immediately preceding the date of the TEMPLE BETH SHALOM Program. Additionally, neither I nor any such Participant will attend any TEMPLE BETH SHALOM Program if any of us have been within fourteen (14) days immediately preceding the date of the TEMPLE BETH SHALOM Program in the presence of any person who we knew or had reason to believe at the time of such encounter had COVID-19, had tested positive for COVID-19 within such fourteen (14) day period, or who evidenced COVID-19 like symptoms within such fourteen (14) day period. In addition, it is understood that this Waiver is a living document and that it shall apply to factors existing at the time of execution and also to any and all situations that may occur hereafter. I agree on my own behalf and that of all Participants listed below to be bound by all provisions of this Waiver without need for execution of any further instrument. I will also contact TEMPLE BETH SHALOM if any Participant listed below becomes ill or tests positive for Covid19 within 7 days after attending a TEMPLE BETH SHALOM Program.

I agree to follow any rules put in place by Temple Beth Shalom and the most current health protocols prescribed by the Governor, local officials, the U.S. Centers for Disease Control and Prevention, and the Texas Department of State Health Services at all times attending Temple Beth Shalom activities or events related to Temple Beth Shalom. Failure to do so may result in my removal from the activity or event.

Additionally, by executing this Waiver, I acknowledge that I have read the foregoing and fully understand the terms and consequences of the Waiver.
this is a confirmation email address
Fri, May 14 2021 3 Sivan 5781