GSWNY COVID‐19 Waiver of Liability
I acknowledge the contagious nature of the Coronavirus/Covid-19 and that the CDC and
many other public health authorities
still recommend practicing social distancing.
I further acknowledge that Girl Scouts of Western New York (GSWNY) has put in place
preventative measures to reduce the spread of the Coronavirus/COVID‐19.
I understand that GSWNY cannot guarantee that I will not become infected with the
Coronavirus/COVID‐19. I acknowledge 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, GSWNY staff, visitors, and their families.
I voluntarily seek services provided by GSWNY, and acknowledge that I may be increasing my
risk of exposure to the Coronavirus/COVID‐19. I acknowledge that I must comply with all set
procedures adopted by the Council in an effort to reduce the likelihood of exposure and/or
spread of Coronavirus/COVID‐19 while onsite.
I hereby release and agree to hold GSWNY 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 Council, or that may otherwise arise in any
way in connection with any services provided by GSWNY. I understand that this release
discharges GSWNY from any liability or claim that I, my heirs, or any personal representatives
may have against GSWNY 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
GSWNY. This liability waiver and release extends to GSWNY together with all owners,
partners, and employees.
e (please print): _________________________________________
Annual Permission Form