COVID Participation Waiver for Adults

NOTICE AND WAIVER FOR ALL ADULT VOLUNTARY ACTIVITY PARTICIPANTS at the
Battle Creek Public Schools Outdoor Education Center, Clear Lake Camp
10160 S M-37 Hwy, Dowling, MI 49050. 269-721-8161. www.clearlakecamp.org

Name Name * First Last
Email *
I agree to participate in (ACTIVITY)
which will take place at BATTLE CREEK PUBLIC SCHOOL OUTDOOR EDUCATION CENTER (OEC) during the dates of
I have read and agree to follow OEC participation rules. I agree that participation in the above noted activity is voluntary, and I have knowledge of and assume all risks for the activity to include injuries as well as exposure to communicable disease, including COVID19. I certify that I understand current COVID19 risks and symptoms and current CDC guidelines. I certify that I have not had any symptoms of a COVID19/coronavirus nor been exposed to anyone who has had such symptoms or diagnosis in the last 14 days. I agree to notify the School District of any changes and I will NOT participate if any symptoms develop or with notice of an exposure to COVID19 until medically cleared. I understand that this discharges the Battle Creek Public School District, OEC, ITS EMPLOYEES, and AGENTS from any liability or claim. Battle Creek Public School District, OEC, ITS EMPLOYEES, and AGENTS will not assume responsibility for any injury or illness incurred while participating in the program or any physically related activity. Certain risks are inherent during participation in these events. Nor will the OEC or its employees or agents be liable for lost or stolen items while participants are using the facilities or are on the premises. I release and waive all claims against the Battle Creek Public School District, OEC, ITS EMPLOYEES, and AGENTS from any and all injuries or damages I may suffer as a result of my participation in the activity. I agree to indemnify and hold the Battle Creek Public School District, OEC, ITS EMPLOYEES, and AGENTS harmless from any claims.
PARTICIPANT signature. Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / MM / DD YYYY