I understand that by attending this group activity of the Spina Bifida Coalition of Cincinnati, I may put myself and/or my child(ren) at some risk of contracting COVID-19. I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person- to-person contact; and, as a result, federal and state health agencies recommend social distancing, especially for those not vaccinated for COVID-19.
I recognize that the staff and Board of Directors of the Spina Bifida Coalition are closely monitoring this situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19, in order to provide activities that comply with the guidelines set by the State of Ohio for public gatherings. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of participating in this activity. I hereby acknowledge and assume the risk of myself and/or my child(ren) becoming infected with COVID-19.
I understand that possible exposure to COVID-19 during this activity may result in the following: a positive COVID-19 diagnosis, extended quarantine/self- isolation, additional tests, hospitalization that may require medical therapy, intensive care treatment, possible need for intubation/ventilator support, short-term or long- term intubation, other potential complications, and the risk of death.
I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to participate in today’s planned activities.
Voluntary Execution
By clicking on the checkbox and completing this registration, I attest that I have read and fully understand this ACKNOWLEDGEMENT and have voluntarily executed the same on behalf of my minor child and/or myself. I agree that this release will remain in effect until terminated by myself in writing. I represent that I have the authority as parent, custodian or guardian of the minor child participant to execute this agreement on his/her behalf.