Men’s Retreat 2021 COVID-19 Waiver

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Please check the following Acknowledgments:*

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I acknowledge that Productive Learning, LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I acknowledge that Productive Learning LLC cannot guarantee that I will not become infected with the Coronavirus/COVID-19 and understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to staff, and other clients and their families.
I acknowledge that I voluntarily seek services provided by Productive Learning LLC and understand that I am increasing my risk to exposure to the Coronavirus/COVID-19.
I acknowledge that I must comply with all set procedures to reduce the spread while attending my workshop.

I attest to the following, and am checking these boxes within 48 hours of the start day of the in person workshop.*

I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
I have not traveled internationally within the last 14 days.
I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
I have not been diagnosed with Coronavirus/COVID-19 and not yet cleared as non-contagious by state or local public health authorities.
I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I will submit a confirmed negative Coronavirus/COVID-19 test or proof of vaccination with this waiver.

Consent*

I hereby release and agree to hold Productive Learning LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of Productive Learning, or that may otherwise arise in any way in connection with any services received from Productive Learning LLC. I understand that this release discharges Productive Learning LLC from any liability or claim that I, my heirs, or any personal representatives may have against Productive Learning with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Productive Learning LLC. This liability waiver and release extends to Productive Learning together with all owners, partners, and employees.

Signature

Upload Negative COVID-19 Results OR Proof of Vaccination.

If you are providing a negative COVID-19 test it must be done within 48 hours of the start day of the in person workshop. You may also upload a test receipt, or proof of cost, for reimbursement.

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Men’s Retreat 2021 COVID-19 Waiver

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