covid-19 release form

CLIENT COVID‐19 RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID‐19

The current worldwide Coronavirus pandemic (“Covid‐19”) is having a dramatic and unprecedented impact on the world, including Freedom Service Dogs (“FSD”). Due to the novel nature of the disease, information related to the COVID‐19 situation is continuously developing and changing.

Based on the Center for Disease Control’s (“CDC’s”) guidelines, COVID‐19 can be spread through person‐to‐person contact and contact with contaminated surfaces or objects. Additionally, data suggests that many confirmed COVID‐19 cases may have moderate to no symptoms but still be highly contagious.

The inherent nature of many aspects of obtaining a service dog (e.g., working with dog trainers and going into public places, etc.) may require contact with people involved in the process or contact with surfaces or objects that were previously contacted by someone else. These “contacts” may mean a higher risk of contracting COVID‐19. Additionally, people that fall into an “at‐risk” category, such as having certain pre‐existing conditions or advanced age, have a significantly higher risk of serious illness caused by COVID‐19.

FSD has put into place preventative measures recommended by the Center for Disease Control (CDC) and Colorado Tri‐ County Health Department to reduce the spread of COVID‐19; however, we cannot guarantee that you or your family will not become infected with COVID‐19.

By signing this agreement, I acknowledge the contagious nature of COVID‐19 and voluntarily assume the risk that I and my family may be exposed to or infected by COVID‐19 while participating in FSD’s match meetings, training programs, and public outings and that such exposure or infection may result in personal injury, illness, permanent disability, and/or death. I understand the risk of becoming exposed to or infected by COVID‐10 at FSD may result from the actions, omissions, or negligence of myself and others, including, but not limited to FSD employees, volunteers and other clients and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to me or my family (including but not limited to personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my family may experience or incur in connection with my or my family’s participation in meetings, trainings or public outings associated with obtaining my or my child’s service dog (“Claims”).

On my behalf and on behalf of my family, I hereby release, covenant not to sue, discharge, and hold harmless FSD, its employees, volunteers, agents and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of FSD staff, volunteers, agents and representatives, whether a COVID‐19 infection occurs before, during and after participation in any FSD meeting, training or public outing associated with obtaining my or my child’s service dog.

Printed name of Client
Printed name of Guardian if child is under 18 yrs of age
Signature of Client or Guardian if child is under 18 yrs of age
Date
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