The Depot Youth Center


Noroton Heights Depot COVID Informed Consent Waiver
Student First Name *
Student Last Name *
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
Noroton Heights Depot, Inc. (The Depot Youth Center) has put in place preventive measures to reduce the spread of COVID-19; however, The Depot Youth Center cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending The Depot could increase your risk and your child(ren)’s risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of cOVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the clubs and programs offered by The Depot Youth Center, and that such from the actions, omissions, or negligence of myself and others, including, but not limited to, Depot employees, volunteers, and program participants and their families
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, buy not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at The Depot or participation in Club programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless The Depot, it’s employees, agents, and representatives, of and from Claims, including liabilities, claims, actions, damages, costs or expense 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 The Depot., it’s employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Depot program.
Parent/Guardian Signature *

Timeout Warning

Noroton Heights Depot COVID Informed Consent Waiver

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19