Liability Waiver and Release Form

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Louisiana Academy of Physician Assistants

Attendee Information

Coronavirus Disease 2019/COVID-19SARS-CoV-2

Liability Waiver and Release Form



I acknowledge the contagious nature of the Coronavirus Disease 2019/COVID-19/SARS-CoV02 (collectively referred to as ‘COVID-19”) and that the CDC and many other public health authorities still recommend practicing social distancing.

I further acknowledge that the Louisiana Academy of Physician Assistants (hereinafter sometimes referred to as “LAPA” or “Organization”) has put in place preventative measures intended to reduce the spread of the COVID-19 for this LAPA event.

I further acknowledge that the LAPA cannot guarantee that I will not become infected with the COVID-19. I understand that the risk of becoming exposed to and/or infected by the COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, the LAPA volunteers and staff and/or other attendees.

I am voluntarily attending this LAPA event and acknowledge that I am increasing my risk of exposure to the COVID-19. I acknowledge that I will comply with all set procedures to reduce the spread of the COVID-19 while attending this LAPA event.

I attest that:

  • I will not attend the LAPA event if I am experiencing any symptom of illness such as cough, shortness of breath, difficulty breathing, fever, chills, shaking with chills, muscle ache or pain, headache, sore throat, or new loss of taste or smell.
  • I will not attend this LAPA event if I have recently been exposed to someone with a suspected and/or confirmed case of the COVID-19.
  • I will not attend this LAPA event if I have been diagnosed with the COVID-19 and not yet been cleared as non-contagious by a medical provider or local or state public health authorities.
  • I will follow all CDC recommended guidelines as much as possible and limit my exposure to the COVID-19 during this LAPA event.

I hereby release and agree to hold the LAPA harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the organization, or that may otherwise arise in any way in connection with any services received from the LAPA. I understand that this release discharges the LAPA from any liability or claim that I, my heirs, or any personal representatives may have against the Organization with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from the LAPA. This liability waiver and release extends to the Organization together with officers, Board Members, volunteers, staff, and members.




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