COVID-19 Waiver

Home / COVID-19 Waiver

COVID-19 Contact Information

    First Name (required)

    Last Name (required)

    Phone (required)

    Your Email (required)

    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 the Lewisboro Horsemen's Association cannot guarantee that I will not become infected with the Coronavirus/Covid-19.

    * I understand 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, staff, and other participants and their families.

    * I voluntarily seek services provided by the Lewisboro Horsemen's Association and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19.

    * I acknowledge that I must comply with all set procedures to reduce the spread while attending any of the Lewisboro Horsemen's Association events.

    I attest that:

    * I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.

    * I have not traveled internationally within the last 14 days.

    * I have not traveled to a highly impacted area within the United States of America in the last 14 days.

    * I have not been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.

    * I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.

    * I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

    I represent that:

    * To the best of my knowledge (as of today’s date, as well as the date of any Lewisboro Horsemen's Association event), (a) I am healthy and free of COVID—19 and its symptoms; and (b) Within the past 14 days, I have not traveled outside of the states of NY, CT, NJ and MA or been in contact with anyone who has COVID—19.

    Release Agreement:

    * I hereby release and agree to hold the Lewisboro Horsemen's Association 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 stable, or that may otherwise arise in any way in connection with any services received from from the Lewisboro Horsemen's Association.

    * I understand that this release discharges from the Lewisboro Horsemen's Association from any liability or claim that I, my heirs, or any personal representatives may have against the stable 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 the Lewisboro Horsemen's Association. This liability waiver and release extends to the all owners, agents, partners, volunteers and employees.

    Use your mosue or finger to sign here:

    By drawing/clicking/tapping/touching/selecting or otherwise interacting with the Signature Panel button above, you are consenting to signing this Document electronically. You agree your electronic signature ("E-Signature") is the legal equivalent of your manual signature on this Document.