Personal Injury and Covid Release Form

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Photo Release Form
March 29, 2022

I, __________________, the participant in Fortitude Careers (the “Program”), enter into and agree to become legally bound by this RISK ACKNOWLEDGMENT, RELEASE, AND LIABILITY WAIVER AGREEMENT RELATING TO CORONAVIRUS / COVID-19 AND PERSONAL INJURY (the “Agreement”) and acknowledge and agree to the following as conditions of my participation in the Program.

 

  1. On or about March 11, 2020, Coronavirus Disease 2019 (“COVID-19”) was declared a pandemic by the World Health Organization, and that the United States Centers for Disease Control and Prevention has stated, “the best way to prevent illness is to avoid being exposed to this virus.” See, https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html
  2. I am aware of the existence of the risk on my physical participation in the activities of the organization that may cause injury or illness such as but not limited to influenza, MRSA, 

COVID-19 that may lead to paralysis or death.

  1. I represent that I have not experienced symptoms of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any other communicable disease within the last 14 days. 
  2. I hereby declare that I am fully and personally responsible for my own safety and actions while and during my participation and I recognize that I may be in any case be at a risk of contracting COVID-19.
  3. I hereby release, waive, discharge Fortitude Careers from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.
  4. I agree to indemnify, defend and hold harmless Fortitude Careers from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss or death from or related to COVID-19. 
  5. I represent and warrant that I am the person whose name appears below and that I have, as of the date hereof, have taken all necessary actions to authorize the execution of this Agreement and have the full power, authority, and legal right to execute, deliver, and perform the respective obligations under this Agreement.

 

Intending to be legally bound, I am executing this Agreement as of the date written below.

 

Signature: _____________________________________________________ 

Date: _________________________

 

PERSONAL INJURY WAIVER FORM

 

  1. I hereby acknowledge the physical nature of the activities that I will engage in at Fortitude Careers.
  2. I hereby acknowledge the risks, foreseeable and unforeseeable, in any way connected with my participation in the Program.
  3. I am aware of the injuries associated with the kind of activities undertaken in the program. I undertake to exercise care while participating in the activities.
  4. I release Fortitude Careers and its trustees, directors, officers, employees, agents, volunteers, successors, and assigns from any and all liability for, and waive any and all claims for, injury, loss, or damage in any way connected with my participation in the program, including injury, loss, or damage caused in whole or in part by the negligence or other misconduct of Fortitude Careers or any other individuals.
  5. I agree to indemnify and to hold harmless Fortitude Careers and all individuals concerning any claim or expenses (including attorneys’ fees and other costs of defending any claim by a third party or that I might take, or that might be made on my behalf) in any way connected with a claim.

 

I have read and fully understand, agree to, and accept all provisions of this personal injury waiver form voluntarily.

 

Signature: __________________________

Printed Name: __________________________

Date: _____________________________

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