To Download the Volunteer Waiver, please select one of these files.
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STATEMENT OF UNDERSTANDING,
CONSENT FORM AND LIABILITY WAIVER FOR VOLUNTEERS
I, ________________, wish to volunteer or participate in events at St. Peter and Paul Parish of Mazeppa (herein after “the Parish”). I understand that my desire to volunteer or participate in events at the Parish is discretionary and do so mindful of the current pandemic related to COVID-19.
The novel coronavirus, COVID-19, has been declared a worldwide pandemic and is extremely contagious. As a result, in order to resume parish activities (“Parish”), social distancing and other essential safety measures at the parish have been established. The Parish has put in place reasonable preventative measures and standards of behavior to reduce the spread of COVID-19 at their activities. Even with implementation of safety protocols, the Parish cannot guarantee that you or your child(ren) will not become infected with COVID-19 and attendance at the Parish and/or participation in Parish activities could increase your risk and/or your child(ren)'s risk of contracting COVID-19.
By signing this agreement, I/we acknowledge the contagious nature of COVID-19 and that my/our child(ren) and I/we may be exposed to or infected by COVID-19 by attending and/or volunteering, and/or by participating in Parish activities, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I/we understand that the risk of becoming exposed to or infected by COVID-19 at the above named Parish may result from the actions, omissions, or negligence of myself/ourselves and others, including, but not limited to Parish employees, volunteers, and program participants and their families.
I/we further agree on behalf of myself/ourselves, my/our child (student) named herein, and my/our heirs, successors, and assigns, to absolutely release, defend, indemnify, and hold harmless the named Parish, canonical administrator(s), and the Catholic Diocese of Winona-Rochester, the parishes within the geographical boundaries of the Diocese of Winona-Rochester, its priests, bishops, members, directors, officers, employees, attorneys, agents and representatives ("Indemnitees") associated with the Parish and arising from or in connection with any alleged negligent acts or omissions of the Indemnitees, from any and all claims and causes of action in any way related to attendance or working at the Parish, including but not limited to any claims of negligent exposure.
By execution of this Statement, I affirm that I have read the following questions:
1. Have you had a fever as defined by the Minnesota Department of Health during the past 24 hours?
2. Have you had a new or unexpected cough during the past 7 days?
3. Have you been around anyone exhibiting these symptoms within the past 14 days?
4. Are you living with anyone who has been sick, has exhibited symptoms of COVID-19, or is currently under quarantine for exposure to COVID-19?
By execution of this Statement, I affirm that I have read the foregoing questions, affirm that my answer is "No" to each of the foregoing questions. I understand that if my answer to any of the foregoing questions on any given day is "Yes," I am not permitted to volunteer at the Parish.
I understand that I may not return to the Parish until I have met the CDC's criteria to discontinue home isolation:
A. If a sick staff member or student suspects or knows they had COVID-19, and had symptoms, they may return to the Parish after:
1. 3 days with no fever;
2. Symptoms improved, and
3. 10 days since symptoms first appeared.
Depending my healthcare provider's advice and availability of testing, they might get tested to see if they still have COVID-19. If tested, they may return to the parish when they have no fever, symptoms have improved, and they receive two negative test results in a row, at least 24 hours apart.
I understand that anyone who has close contact with someone with COVID-19 may not return to the Parish for 14 days after exposure.1
I understand and hereby authorize the Parish to enforce such other reasonable measures and directives as may be deemed necessary by the Bishop of the Diocese of Winona-Rochester, John M. Quinn, or by the Pastor. I further understand that, in the event that it becomes necessary that classes should be administered via distance learning, I will not be entitled to a refund of any of my tuition fees.
I/we further agree on behalf of myself/ourselves, my/our child (student) named herein that if any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
By execution of this Statement, I understand and agree to the foregoing terms and conditions.
Volunteer: ___________________________________________
Date: ________________
ACCEPTED:
Laurie Opseth, Bookkeeper: ___________________________________________
Date: ________________
1 https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprevent-getting-sick%2Fwhen-its-safe.html.
CONSENT FORM AND LIABILITY WAIVER FOR VOLUNTEERS
I, ________________, wish to volunteer or participate in events at St. Peter and Paul Parish of Mazeppa (herein after “the Parish”). I understand that my desire to volunteer or participate in events at the Parish is discretionary and do so mindful of the current pandemic related to COVID-19.
The novel coronavirus, COVID-19, has been declared a worldwide pandemic and is extremely contagious. As a result, in order to resume parish activities (“Parish”), social distancing and other essential safety measures at the parish have been established. The Parish has put in place reasonable preventative measures and standards of behavior to reduce the spread of COVID-19 at their activities. Even with implementation of safety protocols, the Parish cannot guarantee that you or your child(ren) will not become infected with COVID-19 and attendance at the Parish and/or participation in Parish activities could increase your risk and/or your child(ren)'s risk of contracting COVID-19.
By signing this agreement, I/we acknowledge the contagious nature of COVID-19 and that my/our child(ren) and I/we may be exposed to or infected by COVID-19 by attending and/or volunteering, and/or by participating in Parish activities, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I/we understand that the risk of becoming exposed to or infected by COVID-19 at the above named Parish may result from the actions, omissions, or negligence of myself/ourselves and others, including, but not limited to Parish employees, volunteers, and program participants and their families.
I/we further agree on behalf of myself/ourselves, my/our child (student) named herein, and my/our heirs, successors, and assigns, to absolutely release, defend, indemnify, and hold harmless the named Parish, canonical administrator(s), and the Catholic Diocese of Winona-Rochester, the parishes within the geographical boundaries of the Diocese of Winona-Rochester, its priests, bishops, members, directors, officers, employees, attorneys, agents and representatives ("Indemnitees") associated with the Parish and arising from or in connection with any alleged negligent acts or omissions of the Indemnitees, from any and all claims and causes of action in any way related to attendance or working at the Parish, including but not limited to any claims of negligent exposure.
By execution of this Statement, I affirm that I have read the following questions:
1. Have you had a fever as defined by the Minnesota Department of Health during the past 24 hours?
2. Have you had a new or unexpected cough during the past 7 days?
3. Have you been around anyone exhibiting these symptoms within the past 14 days?
4. Are you living with anyone who has been sick, has exhibited symptoms of COVID-19, or is currently under quarantine for exposure to COVID-19?
By execution of this Statement, I affirm that I have read the foregoing questions, affirm that my answer is "No" to each of the foregoing questions. I understand that if my answer to any of the foregoing questions on any given day is "Yes," I am not permitted to volunteer at the Parish.
I understand that I may not return to the Parish until I have met the CDC's criteria to discontinue home isolation:
A. If a sick staff member or student suspects or knows they had COVID-19, and had symptoms, they may return to the Parish after:
1. 3 days with no fever;
2. Symptoms improved, and
3. 10 days since symptoms first appeared.
Depending my healthcare provider's advice and availability of testing, they might get tested to see if they still have COVID-19. If tested, they may return to the parish when they have no fever, symptoms have improved, and they receive two negative test results in a row, at least 24 hours apart.
I understand that anyone who has close contact with someone with COVID-19 may not return to the Parish for 14 days after exposure.1
I understand and hereby authorize the Parish to enforce such other reasonable measures and directives as may be deemed necessary by the Bishop of the Diocese of Winona-Rochester, John M. Quinn, or by the Pastor. I further understand that, in the event that it becomes necessary that classes should be administered via distance learning, I will not be entitled to a refund of any of my tuition fees.
I/we further agree on behalf of myself/ourselves, my/our child (student) named herein that if any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
By execution of this Statement, I understand and agree to the foregoing terms and conditions.
Volunteer: ___________________________________________
Date: ________________
ACCEPTED:
Laurie Opseth, Bookkeeper: ___________________________________________
Date: ________________
1 https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprevent-getting-sick%2Fwhen-its-safe.html.
