SAFETY ACKNOWLEDGEMENT -- COVID LIABILITY WAIVER AND RELEASE OF CLAIMS

SAFETY INFORMATION

While participating in group events held or sponsored by the Northern California Psychiatric Society (“NCPS”), “social distancing” is recommended per current CDC Guidelines. Except when eating or drinking, it is recommended that face coverings will be worn when attending NCPS group events to reduce the risk of exposure to SARS-COV-2 and other similar virus(es). In specific small group activities in which social distancing is not possible, it is recommended that participants comply with any other precautionary measures recommended by NCPS to limit viral transmission. NCPS has taken preventative measures to reduce the spread of SARS-COV-2, but cannot guarantee that meeting participants, volunteers, speakers, partners, or others in attendance will not become infected with SARS-COV-2.

In light of the ongoing spread of SARS-COV-2, individuals who have not been vaccinated against the virus and / or meet any of the following criteria are asked not to attend NCPS face-to-face events or meetings.

Quarantine has been recommended because of a known exposure to another person with a confirmed or suspected case of COVID19 within 14 days.
Current or recent diagnosis with COVID19 and not yet cleared as non-contagious by state or local public health authorities or their health care professional.
Current symptoms associated with COVID19 by any individual who should quarantine because of a known exposure to another person with a confirmed or suspected case of COVID19 within 14 days.

Full Name

Initials 1 *

DUTY TO SELF-MONITOR

I agree to self-monitor for signs and symptoms of COVID19.

Initials 2 *

LIABILITY WAIVER AND RELEASE OF CLAIMS

I acknowledge that I willingly engage in NCPS events and/or other NCPS activities.

Initials 3 *

RELEASE AND WAIVER

I, , HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE ANY AND ALL LIABILITY, CLAIMS, AND DEMANDS OF WHATEVER KIND OR NATURE AGAINST THE NORTHERN CALIFORNIA PSYCHIATRIC SOCIETY AND ITS AFFILIATED PARTNERS AND SPONSORS, INCLUDING IN EACH CASE, WITHOUT LIMITATION, THEIR DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS, AND AGENTS (THE “RELEASED PARTIES”), EITHER IN LAW OR IN EQUITY, TO THE FULLEST EXTENT PERMISSIBLE BY LAW, INCLUDING BUT NOT LIMITED TO DAMAGES OR LOSSES CAUSED BY THE NEGLIGENCE, FAULT OR CONDUCT OF ANY KIND ON THE PART OF THE RELEASED PARTIES, INCLUDING BUT NOT LIMITED TO DEATH, BODILY INJURY, ILLNESS, ECONOMIC LOSS OR OUT OF POCKET EXPENSES, OR LOSS OR DAMAGE TO PROPERTY, WHICH I, MY HEIRS, ASSIGNEES, NEXT OF KIN AND/OR LEGALLY APPOINTED OR DESIGNATED REPRESENTATIVES, MAY HAVE OR WHICH MAY HEREINAFTER ACCRUE ON MY BEHALF, WHICH ARISE OR MAY HEREAFTER ARISE FROM MY PARTICIPATION WITH THE ACTIVITY.

Initials 4 *

ASSUMPTION OF THE RISK. I acknowledge and understand the following:

Participation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. While rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.
I knowingly and freely assume all such risks related to illness and infectious diseases, such as COVID-19, even if arising from the negligence or fault of the Released Parties.
I hereby knowingly assume the risk of injury, harm and loss associated with the Activity, including any injury, harm and loss caused by the negligence, fault or conduct of any kind on the part of the Released Parties.

Initials 4b *

MEDICAL ACKNOWLEDGMENT AND RELEASE

I acknowledge the health risks associated with the NCPS Activity/Event, including but not limited to transient dizziness, lightheaded, fainting, nausea, seizure, muscle cramping, musculoskeletal injury, joint pains, sprains and strains, heart attack, or stroke. I agree that if I experience any of these or any other symptoms during the NCPS Activity/Event, I will discontinue my participation immediately and seek appropriate medical attention. I DO HEREBY RELEASE AND FOREVER DISCHARGE THE RELEASED PARTIES FROM ANY CLAIM WHATSOEVER WHICH ARISES OR MAY HEREAFTER ARISE ON ACCOUNT OF ANY FIRST AID, TREATMENT, OR SERVICE RENDERED IN CONNECTION WITH MY PARTICIPATION IN THE ACTIVITY.

Initials 5 *

As a participant, volunteer, or attendee, I recognize that my participation, involvement and/or attendance at any Northern California Psychiatric Society event or activity (“Activity”) is voluntary and may result in personal injury (including death) and/or property damage. By attending, observing or participating in the Activity, I acknowledge and assume all risks and dangers associated with my participation and/or attendance at the Activity, and I agree that: (a) the Northern California Psychiatric Society (b) the property or site owner of the Activity, and (c) all past, present and future affiliates, successors, assigns, employees, volunteers, vendors, partners, directors, and officers, of such entities (subsections (a) through (c), collectively, the "Released Parties"), will not be responsible for any personal injury (including death), property damage, or other loss suffered as a result of your participation in, attendance at, and/or observation of the Activity, regardless if any such injuries or losses are caused by the negligence of any of the Released Parties (collectively, the "Released Claims"). BY ATTENDING AND/OR PARTICIPATING IN THE ACTIVITY, YOU ARE DEEMED TO HAVE GIVEN A FULL RELEASE OF LIABILITY TO THE RELEASED PARTIES TO THE FULLEST EXTENT PERMITTED BY LAW.

User Agreement *

I have read and agree to the terms listed above on the Release of Liability waiver.