Please indicate if you any dietary restrictions/food allergies. If there are none, please put NA.

Please list all additional attendees first and last names with age if they are under 18. Please note: childcare not provided for this event.

Please indicate your relationship to your emergency contact.

Assumption of Risk. HASDC has put in place recommended preventative measures with guidance from federal, state, and local officials to reduce the spread of COVID-19; however, it cannot be guaranteed that a HASDC Event participant will be prevented from an exposure to COVID-19. HASDC is strictly following CDC and State of California guidance to help prevent the spread of COVID-19. In consideration of being allowed to participate in HASDC Event activities, the undersigned acknowledges, appreciates, and agrees that: • The risk to have contact with individuals who have been exposed to and/or have been diagnosed with one or more communicable diseases, including but not limited to COVID-19 or other medical conditions, does exist, and it is impossible to eliminate the risk that myself and other participants could be exposed to and/or become infected through contact with or close proximity with an individual with a communicable disease; • By signing this Agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I, or other participants, may be exposed to or infected by COVID-19 by attending HASDC’s Event and that such exposure or infection may result in illness; • I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE ACTS, OMISSIONS, OR NEGLIGENCE OF OTHERS, INCLUDING BUT NOT LIMITED TO THE RELEASEES, and accept and assume sole and full responsibility for any injury to myself including, but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability, action, cost, or expense, of any kind, that I may experience or incur in connection with attendance at HASDC’s Event (“Claims”); • I willingly agree to comply with the stated and customary terms and conditions for attending HASDC’s Event, including, but not limited to, CDC, State of California, and HASDC guidelines (stated below). If I observe any unusual significant hazard during my presence or participation, I will bring such to the attention of the nearest official immediately; • I, for myself, and heirs, assigns, personal representatives and next of kin, hereby release, covenant not to sue, discharge, and hold harmless the Hemophilia Association of San Diego County, the respective officers, board members, officials, agents and/or employees of each entity, other participants, sponsoring agencies, sponsors, advertisers, and the owners and lessors of the premises used to conduct the event (collectively the “RELEASEES”), with respect to any and all claims, or loss or damage to person or property, whether arising from the negligence of the releases or otherwise; By attending an HASDC Event, I certify that I do not fall into any of the following categories: • Individuals who currently or within the past fourteen (14) days have experienced any symptoms associated with COVID-19, which include fever, cough, and shortness of breath among others; • Individuals who have traveled at any point in the past fourteen (14) days either internationally or to a community in the U.S. that has experienced or is experiencing sustained community spread of COVID-19; or • Individuals who believe that they may have been exposed to a confirmed or suspected case of COVID- 19 or have been diagnosed with COVID-19 and are not yet cleared as non-contagious by state or local public health authorities or the health care team responsible for their treatment. I further agree to follow the Hemophilia Association of San Diego County’s COVID-19 Guidelines as stated below: • I agree to a COVID-19 health screening upon arrival to HASDC’s Event. • I agree to immediately vacate the premise if I register a temperature of 100.4 or higher. • I agree to wear a face covering when not eating meals, no matter vaccination status. • I agree to always practice safe social/physical distancing protocols. • I agree to wash and/or sanitize my hands frequently. • I agree to avoid all physical contact with other guests or participants not in my immediate household including but not limited to handshakes and/or hugs. • If not vaccinated, I agree to wear a mask over my mouth and nose while inside a facility, in accordance with current California State guidelines. If for health reasons I cannot wear a mask while at HASDC’s Event, I agree to be especially aware of proper social/physical distancing protocols. • I agree to remain with my immediate family/group and keep at least six feet from other individuals outside of my family unit. • I acknowledge that HASDC cannot guarantee that I will not become infected by coronavirus/COVID-19, and further acknowledge that HASDC has put into practice preventative measures to reduce the spread of the coronavirus/COVID-19. “A general release does not extend to claims which the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.” ______By signing below, I certify that: (1) I fully and completely read and understand this COVID Waiver & Release of Liability; (2) I am 18 years of age or older; (3) the information set forth above pertaining to me is true and complete; and (4) I consent and agree to all of the foregoing on behalf of myself identified above. (5) I further acknowledge that nothing in this COVID Waiver & Release of Liability constitutes a guarantee that the Event will occur. ______This consent is on behalf of yourself and all of your additional attendees.