Journey of Life Registration

Registration for Journey of Life

Name *

First

Last

Phone Number *

Email Address *

Gender *

Male Female

Date of Birth *

Shirt Size *

Emergency Contact Info

In case of Emergency, who should we contact? Relationship to Emergency Contact: *

Emergency Phone Number *

How will you attend *

In-Person Zoom Both

COVID sign off:

Precautionary Coronavirus Liability Release Form Due to the 2019-2020 outbreak of the novel Coronavirus, COVID-19, we are taking extra precautions with each participant with a health history review, as well as sanitation and disinfecting practices.

Please complete the following and sign below.
Symptoms of COVID-19 include:
• Fever
• Fatigue
• Dry cough
• Difficulty breathing
I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days. I affirm that I, as well as all household members, have not been diagnosed with COVID19 within the last 30 days. I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days. I affirm that I, as well as all household members, have not traveled outside of the country, or to any city outside of our own that is or has been considered a “hot spot” for COVID- 19 infections within the last 30 days. I understand that Christ Armenian Church and the Bob Waldorf Center cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each participant. By signing below I agree to each above statement and release Christ Armenian Church and Bob Waldfor Center from any and all liability for the unintentional exposure or harm due to COVID-19. Christ Armenian Church and all staff and volunteers agree that they abide by these same standards and affirm the same.