OMEGA PSI PHI FRATERNITY, INC.
COVID-19 WAIVER

Date *

MM

DD

YYYY

Name *

First Name

Last Name

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the Center for Disease Control (CDC) and many other public health authorities still recommend practicing the following precautionary measures, including, but not limited to, social distancing of at least six (6) feet apart, frequent hand-washing or hand-sanitizing, and wearing a face covering or mask over one's mouth and nose. *

Yes

I further acknowledge that The Omega Psi Phi Fraternity, Inc. (OPP) has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. *

Yes

I further acknowledge that OPP and THE CHAPTER cannot and will not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, fraternity members, fraternity staff, other attendees, and their families. *

Yes

I voluntarily seek admission to this event/function held by the Second (2nd) District and/or accept the invitation of Omega Psi Phi and THE CHAPTER provided by members of OPP and THE CHAPTER and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending this event/function. *

Select Event Below:

Charles Drew Memorial Scholarship Fund (CDMSF) Golf Tournament

I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. *

Yes

I have not had a fever above 100 degrees within the preceding 48 hours or the event, and that I have not been exposed to anyone with COVID-19 symptoms within the past 48 hours. *

Yes

I have not traveled internationally within the last 14 days. *

Yes

I have not traveled to a highly impacted area within the United States of America in the last 14 days. *

Yes

I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities. *

Yes

I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. *

Yes

I hereby release and agree to hold OPP and THE CHAPTER 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 OPP and THE CHAPTER, or that may otherwise arise in any way in connection with any invitation received from OPP and THE CHAPTER. I understand that this release discharges OPP and THE CHAPTER from any liability or claim that I, my heirs, or any personal representatives may have against OPP and THE CHAPTER with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any invitation received from OPP and THE CHAPTER. This liability waiver and release extends to OPP together with all owners, partners, and employees. *

PLEASE PROVIDE YOUR ELECTRONIC SIGNATURE BELOW

First Name

Last Name