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Campus COVID-19 Waiver

We all bear a personal responsibility in preventing the spread of COVID-19. Thank you for your commitment to doing your part in keeping our community healthy and safe. This form must be completed for each individual, and either proof of full vaccination (two weeks past the second dose for pfizer and moderna, or the one dose of J&J) or proof of negative PCR test within 72 hours, must be uploaded for entry to any building. If you have difficulty uploading, please bring proof with you on the day that you visit our Temple campus.

Masks are required for everyone entering our campus regardless of vaccination status.
 

Waiver

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Association.  COVID-19 is reported to be extremely contagious.  As a result, federal, state and local governments and agencies recommend social distancing and have, in many locations prohibited the congregation of groups of people. We are doing everything we can to be compliant with all regulations and ensure your safety. We have put in place preventative measures to reduce the spread of COVID-19.

Leo Baeck Temple (‘The Temple’) cannot prevent you or your child(ren) from being exposed to, contracting, or spreading COVID-19 while on our premises.  It is not possible to prevent against the presence of the disease.  Therefore, if you choose to attend events or programs at the Temple, you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

ASSUMPTION OF RISK.  I have read and understood this warning concerning COVID-19.  I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children, including, if I am pregnant, my unborn child(ren), in order to utilize Leo Baeck Temple’s services and enter its premises. 

WAIVER OF LAWSUIT/LIABILITY.   I agree for me, my child, and my spouse to release and waive my right to bring suit against Leo Baeck Temple (“LBT”) and its affiliates,  officers, directors, trustees,  agents, employees, representatives and all other persons or entities acting in any capacity on LBT’s behalf in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Leo Baeck Temple services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injury, death, disease or property losses, or any other loss, including but not limited to claims of negligence, and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.

CHOICE OF LAW.  I understand and agree that the law of the State of California will apply to this waiver.
 
A vaccination card or negative PCR test only needs to be uploaded for services and programs held indoors.
A vaccination card or negative PCR test only needs to be uploaded for services and programs held indoors.

A vaccination card or negative PCR test only needs to be uploaded for services and programs held indoors.
A vaccination card or negative PCR test only needs to be uploaded for services and programs held indoors.
A vaccination card or negative PCR test only needs to be uploaded for services and programs held indoors.
A vaccination card or negative PCR test only needs to be uploaded for services and programs held indoors.
Mon, October 25 2021 19 Cheshvan 5782