The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health
Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact.
This is a community exposure and the City of Clermont is taking reasonable preventative measures in order to reduce
the spread of COVID-19. However, the City of Clermont cannot and does not guarantee that the program/rental
participants, your family or yourself will not become infected with COVID-19.
By signing this Risk Acknowledgment Indemnification/Hold Harmless Form, I, _________________________
(hereinafter named “Organizer”), hereby acknowledge the contagious nature of COVID-19 and voluntarily assume the risk
that program/rental participants, my family, my team or myself may be exposed to and/or infected by COVID-19 by
participating in __________________________________ (hereinafter the "Program/Rental") and that such exposure or
infection may result in personal injury, illness, permanent disability and/or death. I understand the risk of becoming exposed
to and/or infected by COVID-19 while participating in and operating the Program/Rental on or near City of Clermont property
may result from the actions, omissions, or negligence of myself and others, including, but not limited to, City of Clermont
employees, volunteers and other participants. I the Organizer, voluntarily agree to assume all the foregoing risks and accept
sole responsibility for any injury, illness and/or death to any participant, my family or myself.
I consent and agree to comply with all preventative measures required by the City of Clermont and/or the League,
Program, or Rental including, but not limited to, social distancing and Maximum capacity rules. I understand that failure of the
Program/Rental to comply with any request from the City of Clermont or the Program/Rental in relation to any preventative
measures may result in the Program/Rental’s expulsion from the City property and termination of any and all Agreements.
I hereby release, covenant not to sue, discharge, indemnify and hold harmless the City of Clermont, its elected
officials, officers, employees, representatives, agents, volunteers and assigns, of and from any and all claims, including all
liabilities, actions, damages costs or expenses of any kind arising out of or relating to any participation in and/or operations
of the Program.
I represent and warrant that I have carefully read and fully understand all of the provisions of this Risk
Acknowledgment Indemnification/Hold Harmless Form.
(Leagues, pool rental groups, room rentals, program Instructor)
Program name (if applicable):
Organizer/Applicant Signature
Organizer/Applicant Printed Signature
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