Southern HIV Impact Fund (SHIF) Grantee Convening COVID Attestation

 

Please review the following release of liability and check the box to indicate agreement below. I acknowledge and agree to the following:

  • I am aware of the existence of COVID-19, and that my participation in an in-person meeting may cause injury or illness to myself or my family.
  • I will not attend if I have experienced symptoms such as fever, fatigue, difficulty breathing, dry cough or other symptoms relating to COVID-19 within the 48 hours leading up to the event, or if within that time I am isolating, quarantining, or awaiting the results of a COVID-19 test due to possible exposure.
  • I am aware that all Southern HIV Impact Fund Grantee Convening participants are required to be vaccinated against COVID-19 or seek an exemption.
  • During the Southern HIV Impact Fund Grantee Convening, I will comply with local and event health and safety requirements, including recommendations for mask wearing and social distancing, as well as respect the autonomy of other attendees at the meeting.
  • I choose to attend the Southern HIV Impact Fund Grantee Convening in person.
  • I am aware that participation in the Southern HIV Impact Fund Grantee Convening will include interaction with nonparticipants (such as other hotel guests and staff) who may have differing COVID prevention habits (e.g., masking, distancing, etc.). 
  • I am aware of the potential risk of contracting COVID-19 from individuals, even if those individuals do not display any symptoms of the virus. I expressly agree that participation in the Southern HIV Impact Fund Grantee Convening is undertaken at my own risk.
  • I hereby release AIDS United, their employees, officers, directors, or agents; their members or affiliated entities; and their board members from any liability related to contracting or spreading COVID-19, or becoming ill or incurring any personal injury or death from or related to COVID-19 as a result of attending the Southern HIV Impact Fund Grantee Convening 2023 in person. I assume all such risks of illness, injury or death.
  • I hereby waive any right to recovery for any damages related to contracting or spreading COVID-19, or becoming ill or incurring any personal injury or death from or related to COVID-19, against AIDS United; their employees, officers, directors, or agents; their members or affiliated entities; and their board members and agree not to pursue or join any such claims, demands, damages, actions, or causes of action, including but not limited to those that result from any acts of active or passive negligence on the part of any of the foregoing. 
  • I have read and understand this waiver and release of claims, and I understand the risks I am assuming. I am entering into this waiver and release of claims voluntarily.