Today’s Health Attestation: I attest that, at the time of this event, I do not have symptoms of COVID-19 as detailed by the Centers for Disease Control and Prevention. Specifically, I do not have and am not showing symptoms of any of the following: fever, chills, shortness of breath, headache, sore throat, or loss of taste or smell. I attest that I have not tested positive for COVID-19 in the past 14 days, and that I have not had exposure to someone who tested positive for COVID-19 in the past 14 days. I attest that I did not take a COVID-19 test in the past 14 days because I believed that I had COVID-19 symptoms or was exposed to someone with COVID-19.

COVID Waiver and Release: I acknowledge and accept that it is my responsibility to comply with the guidelines of the City of Baltimore and the State of Maryland relating to COVID-19.  With full awareness and appreciation of the risks involved, I on behalf of myself, my family, estate, heirs, executors, administrators, assigns, and personal representatives, hereby release, discharge, hold harmless, and covenant not to sue the Released Parties from any and all liability, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, or injury, including death, that may be sustained by me related to COVID-19, whether caused by negligence of the Released Parties, any third-party , or otherwise, while participating in any activity, facilities, exhibits, programs, materials, or amenities. By signing below, you are agreeing to the waiver as it is stated above.

General Waiver and Release:  I am voluntarily participating in a program/event conducted by the Psi Phi Omega Chapter of Alpha Kappa Alpha, Sorority, Incorporated.  I recognize that the program requires physical exertion that may be strenuous at times and may cause physical injury and I am fully aware of the risks and hazards involved.  I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the program in the above-mentioned program.  I represent and warrant that I have no medical condition that would prevent my participation in the program.  Such injuries may include, but are not limited to heart attacks, stroke, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to head/neck/arms/legs/chest/spine, or any other illness or soreness, including death.  I knowingly, voluntarily, and expressly waive any claim I may have against the Psi Phi Omega Chapter of Alpha Kappa Alpha Sorority, Incorporated for injury or damages that I may sustain as a result of participating in the program.  I, my heirs, or representatives forever release, waive, discharge and covenant not to sue the Psi Phi Omega Chapter of Alpha Kappa Alpha Sorority, Incorporated for any injury or death caused by their negligence or other acts.

Authorization to Use Likeness:  By entering and participating in the program/event, I hereby irrevocably grant the right and permission to Alpha Kappa Alpha Sorority, Incorporated, including Psi Phi Omega Chapter, to film, videotape and photograph, myself and my property, and to have my name, image, picture, likeness, actions, photograph, appearance, voice and other reproductions of my likeness in any media, including advertising/social media campaigns. I acknowledge that any film, videotape, or photographs of myself, my property or my likeness are taken voluntarily and no payments for such items will be made/offered. 

Authorization to Use Email:  Psi Phi Omega may use your email as a form of communication to make you aware of future programs and events.  You are agreeing to release Psi Phi Omega from any liability that may arise from the use of your email for communication.

I have read the above waiver and release of liability and fully understand its contents.  I voluntarily agree to the terms and conditions as stated above.