Certificate in Community Storytelling

COVID-19 Waiver and Release of Liability Form

*You will receive this form in an email to sign before participation in the training*


The Hearth Community (THC) continues to monitor Federal, State, and Local policies and procedures during the COVID-19 pandemic. The safety and well-being of our participants, attendees, staff, and volunteers is our top priority. THC has implemented several preventative measures to reduce the spread of the COVID-19 virus; however, under no circumstances are we able to guarantee that you or any participant will not become infected with the virus.

Please review the agreement below and sign to affirm your intent and commitment to abide by these policies.


  • I declare I am not experiencing or exhibiting any COVID-19 related symptoms as outlined by the federal and state Center for Disease Control and Prevention (CDC) such as fever, dry cough, or shortness of breath.
  • I acknowledge I must follow the safety protocols that have been implemented by THC including practicing social distancing and maintaining separation of six feet from individuals.
  • I declare I have not traveled internationally or to a highly impacted COVID-19 area within the United State during the last (14) days.
  • I am not aware nor do I believe I have been recently exposed to a person or animal with a positive and confirmed case if COVID-19.
  • I acknowledge I may be removed from an event or asked to leave campus property by university personnel should I exhibit any behavior in direct contrast to THC guidelines and safety measures.

By signing this waiver and release of liability form, I acknowledge the contagious and evolving nature of COVID-19 and voluntarily assume the risk that I may be exposed to the virus and become affected as a result. I understand the risk of becoming infected may impact others. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any expense, liability, illness, injury, disability or death related to contracting the virus. ​I hereby release, covenant not to sue, discharge, and hold harmless THC from all claims of any kind arising out of COVID-19. I understand and agree that release of liability includes any claims towards THC, its contractors, employees, agents, and volunteers whether a COVID-19 infection occurrence exists before, during, or after attendance and participation at a THC related activity.

If participant is a minor child under the age of eighteen years, said participant’s adult parent(s) or legal guardian(s) shall be jointly and severally liable for the participant’s performance of this waiver and release of liability form and represent and warrant to THC that they have full authority to enter into this agreement on behalf of such minor.

This waiver and release of liability form shall be governed by and construed under the laws of the State of Oregon, without regard to its choice of law principles. I agree not to commence or prosecute any action in connection herewith other than in the state and/or federal courts of the State of Oregon, Jackson County.

I and my adult parent(s) or legal guardian(s) agree to be bound by all terms of this waiver and release of liability form, as indicated by our signatures below.

Date: _______________

Printed Name: ________________________________

Signature: ___________________________________

(Parent/Guardian For Minor Under Age 18)

Date: _______________

Printed Name: ________________________________

Signature: ____________________________________