COVID-19 Liability Release Waiver SC Summit Jan 21-23, 2022
The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide
pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the
government has set recommendations, guidelines, and some prohibitions which Storm
Consultants. LLC/SRC Summit. (the "Organization") adheres to comply.
In consideration of my participation in the foregoing, the undersigned acknowledge and agree to
the following: I am aware of the existence of the risk on my physical appearance to the venue
and my participation to the activity of the Organization that may cause injury or illness such as,
but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death. I have not
experienced symptoms that of fever, fatigue, difficulty in breathing, or dry cough or exhibiting
any other symptoms relating to COVID-19 or any communicable disease within the last 14 days.
I have not, nor any member(s) of my household, traveled by sea or by air, internationally within
the past 30 days. I did not, nor any member(s) of my household, visit any area within in the
United States that was reported to be highly affected by COVID-19 in the last 30 days. I have not
been, nor any member(s) of my household, diagnosed to be infected of COVID-19 virus within
the last 30 days.
Following the pronouncements above I hereby declare the following:
I am fully and personally responsible for my own safety and actions while during my
participation and I recognize that I may be in any case be at risk of contracting COVID-
With full knowledge of the risks involved, I hereby release, waive, discharge the
Organization, its board, officers, independent contractors, affiliates, employees,
representatives, successors, and assigns from any and all liabilities, claims, demands,
actions, and causes of action whatsoever, directly or indirectly arising out of or related to
any loss, damage, injury, or death, that may be sustained by me related to COVID-19
while participating in any activity while in, on, or around the premises or while using the
facilities that may lead to unintentional exposure or harm due to COVID-19. I agree to
indemnify, defend, and hold harmless the Organization from and against it any and all
costs, expenses, damages, lawsuits, and/or liabilities or claims made by or against any of
the released party due to injury, loss, or death from or related to COVID-19.
By signing below, I acknowledge that I have read the foregoing Liability Release Waiver and
understand its contents; that I am at least eighteen (18) years old and fully competent to give my
consent; That I have been sufficiently informed of the risks involved and give my voluntary in
signing it as my own free act and deed; that I give my voluntary consent in signing the Liability
Release Waiver as my own free act and deed with full intention to be bound by the same, and
free from any inducement or representation.
This waiver will remain effective until laws and mandate relevant to COVID-19 are lifted.
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