COVID-19 Liability Release Waiver for Onsite Participants
This form must be completed and submitted on the same day as the onsite event.
Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), Chinese Bible Church of Greater Boston (CBCGB) is taking extra precautions to care for every staff member, volunteer, and event participant by including a health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance.
I agree to the following:
- I affirm that I, as well as all household members, have checked our temperature with a thermometer today and we do not currently have any of the following symptoms:
- fever (>=100°F [37.8° C]) or feeling feverish/chills
- shortness of breath
- sore throat
- cough
- nasal congestion/runny nose
- muscle aches
- new loss of smell or taste
- If anyone in my household has experienced these symptoms within the past 14 days, we have obtained clearance from our doctor or a negative COVID-19 PCR test result.
- I affirm that I, as well as all household members, have not been exposed to anyone diagnosed with COVID-19 within the past 14 days; or if so, have since obtained a negative COVID-19 PCR test.
- I affirm that I, as well as all household members, have not traveled outside of the US or to any state considered to be a high-risk area (https://www.mass.gov/info-details/covid-19-travel-order) for COVID-19 infections by the MA government within the past 14-days; or if so, have since obtained a negative COVID-19 PCR test.
- I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 30 days.
- I understand that CBCGB cannot be held liable for any exposure to the COVID-19 virus caused by incorrect information on this form or the health history provided by other participants of the CBCGB event.
By submitting the form below, I agree to each statement above and release Chinese Bible Church of Greater Boston from any and all liability for unintentional exposure or harm due to COVID-19.
新冠疫情安全同意書-責任和賠償免除聲明
本聲明適用於教會現場活動參與者。此表格必須在参加教会現場活動當天完成並提交。
由於2019年至2020年新型冠狀病毒的爆發，波士頓郊區華人聖經教會（CBCGB）要求全體員工、志願者、和活動參與者採取謹慎的預防措施，包括檢查健康史、按照美国疾病控制和预防中心的指南改進衛生和消毒程序。
我同意以下聲明：
- 我確認我和所有家庭成員今天已經用溫度計量過體溫，我們目前沒有以下症狀：
- 發燒（高於華氏100度或攝氏37.8度）或畏寒
- 呼吸困難
- 喉嚨痛
- 咳嗽
- 鼻塞/流鼻涕
- 肌肉酸痛
- 喪失嗅覺或味覺。
- 若我們的家庭成員在過去14天內有有這些症狀，我們已經取得醫師的鑑定或新冠病毒陰性檢測結果，被評估可以安全地出席公共場合。
- 我確認我和所有家庭成員在過去14天內未接觸任何被診斷出新型冠狀病毒的人，或是接觸後我們已經測試證實新冠病毒為陰性。
- 我確認我和所有家庭成員在過去的14天內，沒有出國旅行或到過任何被麻州政府視為新型冠狀病毒高危險的區域 (https://www.mass.gov/info-details/covid-19-travel-order)，或是旅行後我們已經測試證實新冠病毒為陰性。。
- 我確認我和所有家庭成員在過去30天內沒有被診斷出新型冠狀病毒。
- 我明白波士頓郊區華人聖經教會不承擔因本表格中的錯誤信息，或因教會活動參與者提供錯誤的健康史而導致會眾染上新型冠狀病毒的責任。
提交以下表格即表示我同意上述所有陳述，並同意免除波士頓郊區華人聖經教會對於意外染上新型冠狀病毒的任何和全部責任。