Electronic Signature and Acknowledgement If under 18 years old, hard copy notarizered waiver is required to be turned in at sign-in.
Enter the date and your full name to acknowledge your electronic signature of this document.



Please Read Carefully


Production Company has put in place preventive measures to reduce the potential spread of the COVID-19 coronavirus which has been declared a worldwide pandemic by the World Health Organization. However, Production Company cannot guarantee that attendees will not become infected with COVID-19 while you are participating in the production.

By signing hereunder, you hereby acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you could be exposed to or infected by COVID-19 while participating and/or providing services for the production, and that such exposure or infection may result in personal injury, illness, permanent disability, or death. Accordingly, as a condition of your participation you hereby confirm the following:


1.    1. I am not currently suffering, and have not suffered within the previous 7 days, from any COVID-19 symptoms including without limitation fever, cough, chills, chest pain, headache, shortness of breath, muscle aches, sore throat, or difficulty breathing.

2.    2. I am not in an at-risk group which would make me particularly vulnerable to COVID-19, including without limitation (a) 70 years old or older; (b) pregnant or recently gave birth; (c) receiving treatment or having a condition that compromises the immune system; (d) having a chronic health condition; or (e) regularly going to a hospital or health care setting for a treatment.

3.     3. In the last 14 days, I have not knowingly been in close physical contact with someone who tested positive for COVID-19 (close physical contact meaning being less than 2 meters away in the same room, workspace, or area, or living in the same home).

4.     4. In the last 14 days, I have not been in close physical contact with a person who either (a) is currently sick with a new cough, fever, or difficulty breathing.

5.     5. I undertake to declare immediately any onset of symptoms or contact with anyone who has symptoms of COVID-19.

6.     6. ISubject to the limitations inherent to the production, I will abide by and respect all health and safety guidelines, protocols, recommendations, and/or government mandated requirements and/or restrictions implemented in connection with the COVID-19 pandemic, including without limitation practicing social distancing, utilizing face masks and other personal protection equipment as may be appropriate in the circumstances.

7.     7. I acknowledge that while implementation of appropriate safety protocols are intended to reduce and mitigate against the risks of exposure to COVID-19, no such safety protocols can fully eliminate such risks.


      Accordingly, I acknowledge that my participation in the production may involve elements of risk and danger relating to potential exposure to COVID-19, as well as elements of risk, danger and physical exertion from the physical and transportation methods and activities involved in this production and that I have been notified of such potential dangers, hazards and/or perils and voluntarily and fully agree to assume all such risks, dangers, hazards, and the possibility of personal injury, illness, death, property damage and loss resulting therefrom. I hereby waive and forever relinquishes all rights and remedies at law or in equity, and releases and forever discharges Production Company, and Production Company’s assignees, and affiliated companies; and such parties’ respective directors, officers, employees and agents (collectively the “Releasees”), and agrees not to sue any of the Releasees, with respect to any claim, demand, suits, cause of action, liability, loss, expense or damage of any nature whatsoever, whether known or unknown or suspected or unsuspected or anticipated or unanticipated, arising out of or connected with my participation in the Production, including claims relating to personal illness or injury, loss of income, property damage or breach of any statutory, fiduciary or other duty of care. I hereby hold harmless and indemnify the Releasees from any and all liability for any damage to property of, physical or mental illness or personal injury to, any third party, resulting specifically from my participation in the Production.


I state that by signing this document I fully read and understood its contents, and that I am voluntarily waiving rights that may be granted to me by International, Federal, State and Local statues, as well as the common law of the nation.



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