COVID Policy (21+) 2020 COVID19 Policy (21+) Name* First Last Phone*Email* Date of Birth Date Format: MM slash DD slash YYYY I agree to Self Monitor for any symptoms related to COVID-19 for a period of at least 2 weeks prior to starting work at Camp, and to report any such symptoms before arriving at Camp* By checking here you agree that you read and understood the statement above I agree to observe and follow all new policies regarding Safety, Sanitation, and Social Distancing put in place by Camp Management* By checking here you agree that you read and understood the statement above. Choice Coronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a mean to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in [Valley Mill Camp’s programs or accessing Valley Mill Camp’s facilities could increase the risk of contracting COVID-19. Valley Mill Camp in no way warrants that COVID-19 infection will not occur through participation in Valley Mill Camp programs or accessing Valley Mill Camp facilities.* By checking here you agree that you read and understood the statement above In consideration of my participation in Valley Mill Camp I agree to release and on behalf of myself, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE Valley Mill Camp, its officers, directors, employees, volunteers, agents, representatives and insurers (“Releasees”) from any causes of action, claims, or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which I, my heirs, representatives, executors, administrators and assigns may have, now or in the future, against Valley Mill Camp on account of personal injury, property damage, death or accident of any kind, arising out of or in any way related to the use of Valley Mill Camp facilities/equipment or participation in Valley Mill Camp programs whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to the negligence of Releasees.* By checking here you agree that you read and understood the statement above In consideration of my participation in Valley Mill Camp, I, the undersigned participant, agree to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to my Valley Mill Camp participation.* By checking here you agree that you read and understood the statement above. Choice I hereby certify that I have full knowledge of the nature and extent of the risks inherent in Valley Mill Camp participation and that I am voluntarily assuming said risks. I understand that I will be solely responsible for any loss or damage, including personal injury, property damage, or death, I sustain while participating in Valley Mill Camp and that by signing this agreement I HEREBY RELEASE Releasees from all liability for such loss, damage, or death. I further certify that I am in good health and that I have no conditions or impairments which would preclude my safe participation in Valley Mill Camp* By checking here you agree that you read and understood the statement above I further certify that I am of lawful age and otherwise legally competent to sign this agreement. I further understand that the terms of this agreement are legally binding and certify that I am signing this agreement, after having carefully read it, of my own free will.* By checking here you agree that you read and understood the statement above By checking the above checkbox, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.* By checking here you agree that you read and understood the statement above Name of Signer First Last