December Parents’ Night Out

I hereby attest that I have been informed of the following information pertaining to COVID-19: (1) COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact (2) Individuals with serious underlying medical conditions are at higher risk for severe illness (3) As with any social activity, participation in Parents' Night Out activities could present the risk of contracting COVID-19. While Berrien UU Fellowship takes every safety and preventive precaution, Berrien UU Fellowship can in no way warrant that COVID-19 infection will not occur through participation in sponsored events. Participation may lead to exposure. Illness or quarantine requirements. I agree that: (1) On behalf of myself and my participating children, I will comply with the most recent guidance and recommendations issued by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and my local state agency or municipality for slowing the transmission of COVID-19. (2) Neither I nor my participating children shall visit or utilize the facilities, services and/or programs of Berrien UU Fellowship within 14 days after returning from highly-impacted areas or exposure to any person who has a suspected or confirmed case of COVID-19 or exposure to any other risk identified by the most recent guidelines or recommendations or situation delineated by WHO, the CDC or my state public health agency or municipality. (3) Neither I nor my participating children shall participate in, visit or utilize the facilities, services and/or programs of the Berrien UU Fellowship if I, he or she experiences symptoms of COVID-19, including without limitation fever, cough, loss of taste or smell or shortness of breath, or has a suspected or diagnosed case of COVID-19.

This Health History is correct as far as I know, and the person herein described has permission to engage in all prescribed event activities except as noted. I hereby give permission to Berrien UU Fellowship to provide routine healthcare in the event of a minor injury. If I cannot be reached in an emergency, I give permission to medical personnel to hospitalize, secure proper treatment for, and order injection, anesthesia or surgery for my child. I understand the information on this form will be shared on a "need to know" basis and with adult volunteers and child care workers. I give permission to photocopy this form.