COVID Waiver

ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND RESPONSIBILITY RELEASE OF LIABILITY AND WAIVER OF LEGAL RIGHTS

I. COVID-19 SAFETY INFORMATION

I understand that the Center for Disease Control and Prevention (CDC) has issued safety guidelines regarding COVID-19. I certify that I have reviewed these guidelines (available at www.cdc.gov).

I have willingly and voluntarily applied to the City Union Mission Inc.’s volunteer program. I understand that as a volunteer with the City Union Mission Inc., no compensation or traditional employment benefits are expected in return for my services.

Prior to entering facilities or activities of City Union Mission Inc., I will reconfirm the below information is true. If reconfirmation is not agreed to, I will not be allowed to participate as a volunteer.

  • I am not currently experiencing any symptoms of COVID-19 and am not currently undergoing treatment for COVID-19 or have been directed to self-quarantine.
  • During the 14 days prior to trip participation, I have not come into close contact with anyone I know who is currently infected with COVID-19, undergoing treatment for COVID-19, who has been directed to self-quarantine or who has symptoms of COVID-19 and is awaiting a test or a test result.
  • I will wear a face mask if required.

 

II. ASSUMPTION OF RISKS

By signing this waiver, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to COVID-19 by participating in this activity and that such exposure may result in contracting COVID-19. I understand and acknowledge that, at times during my participation, I may not be able to maintain the recommended guidelines for social distancing of 6’ (six feet) from other people.

I understand that Volunteers are responsible for their own safety and must show consideration for the safety of staff, guests, approved parties, and other participants. I agree to take full responsibility for my own actions, safety, and welfare. I understand my non-compliance with these measures may result in me not volunteering.

I acknowledge and assume all risk of personal injury, medical treatment, illness, death, or any other loss or property damage resulting from my attendance and/or participation in the Activities.

 

III. LIABILITY WAIVER

I understand that my participation as a volunteer is at my own risk, and I hereby agree to indemnify, hold harmless, and release City Union Mission Inc., as well as its present, former and future officers, directors, agents, and employees from all actions, suits, claims and demands, including but not limited to actions for negligence that I or my heirs, executors, agents, administrators or assigns have or may have, either known or unknown, arising out of my participation in this activity.

I UNDERSTAND THAT IN THE EVENT I AM NOT FULLY VACCINATED AGAINST COVID-19, CITY UNION MISSION, INC. RECOMMENDS THAT I CONSULT WITH MY HEALTH CARE PROVIDER TO DETERMINE IF I SHOULD PARTICIPATE.

I HAVE READ THIS ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND RESPONSIBILITY, RELEASE OF LIABILITY AND WAIVER OF LEGAL RIGHTS AND FULLY UNDERSTAND ITS CONTENTS. I ENTER INTO IT OF MY OWN FREE WILL.

THE SIGNING OF THIS DOCUMENT IS A REQUIREMENT FOR MY PARTICIPATION IN THIS ACTIVITY

 

Additional Mandates for Food Service Volunteers

All volunteers and volunteer groups serving food in the shelters must submit to the following in order to protect themselves and clients of City Union Mission Inc.:

  • Volunteer groups are limited to 16 people in one area at a time. An exemption to this limit may be determined in certain situations if deemed necessary by the Volunteer Coordinator.
  • Masks or facial coverings may be required by CDC shelter guidelines.
  • We prefer food to be served from the kitchen window. However, groups may serve it to the tables if gloves are worn and social distancing is practiced.
  • Prior to entering a City Union Mission Inc. building, each volunteer or volunteer group must review and sign this Acknowledgment and Assumption of Risk and Responsibility and Release of Liability and Waiver of Legal Rights and return it to the Volunteer Coordinator.

 

*By completing the fields below, you are electronically signing this waiver

 

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