DONOR NETWORK WEST 2022 TRANSPLANT GAMES OF AMERICA

COVID-19 SAFETY CERTIFICATION LIABILITY WAIVER AND RELEASE OF CLAIMS

While participating in events related to the 2022 Transplant Games of America, social distancing must be practiced and face coverings worn at all times to reduce the risks of exposure to COVID-19. Donor Network West cannot guarantee that participants, volunteers, partners, or others in attendance will not become infected with COVID-19.

In light of the ongoing spread of COVID-19, individuals who fall within any of the categories below should not engage in Transplant Game-related events. By attending an event, and signing below, you certify that you do not fall into any of the following categories:

1.             Individuals who currently or within the past fourteen (14) days have experienced any symptoms associated with COVID-19, which include fever, cough, and shortness of breath, among others.

 2.               Individuals who have traveled at any point in the past fourteen (14) days either internationally or to a community in the U.S. that has experienced or is experiencing sustained community spread of COVID-19; or

3.             Individuals who believe that they may have been exposed to a confirmed or suspected case of COVID- 19 or have been diagnosed with COVID-19 and are not yet cleared as non-contagious by state or local public health authorities or the health care team responsible for their treatment.

LIABILITY WAIVER AND RELEASE OF CLAIMS:

I acknowledge that I derive personal satisfaction and a benefit by virtue of my participation and/or voluntarism with Donor Network West, and I willingly engage in these events and/or other fundraising activities (the “Activity”).

I HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE ANY AND ALL LIABILITY, CLAIMS, AND DEMANDS OF WHATEVER KIND OR NATURE AGAINST DONOR NETWORK WEST AND ITS AFFILIATED PARTNERS AND SPONSORS, INCLUDING IN EACH CASE, WITHOUT LIMITATION, THEIR DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS, AND AGENTS (THE “RELEASED PARTIES”), EITHER IN LAW OR IN EQUITY, TO THE FULLEST EXTENT PERMISSIBLE BY LAW, INCLUDING BUT NOT LIMITED TO DAMAGES OR LOSSES CAUSED BY THE NEGLIGENCE, FAULT OR CONDUCT OF ANY KIND ON THE PART OF THE RELEASED PARTIES, INCLUDING BUT NOT LIMITED TO DEATH, BODILY INJURY, ILLNESS, ECONOMIC LOSS OR OUT OF POCKET EXPENSES, OR LOSS OR DAMAGE TO PROPERTY, WHICH I, MY HEIRS, ASSIGNEES, NEXT OF KIN AND/OR LEGALLY APPOINTED OR DESIGNATED REPRESENTATIVES, MAY HAVE OR WHICH MAY HEREINAFTER ACCRUE ON MY BEHALF, WHICH ARISE OR MAY HEREAFTER ARISE FROM MY PARTICIPATION WITH THE ACTIVITY.

Your completion of the sign off fields below certifies the foregoing and signifies your agreement to these terms.

 I hereby authorize the use of photographs, video and/or the public release of information regarding the donation, recovery and/or transplant of organs and/or tissues by Donor Network West for permitted uses, e.g., dissemination to Donor Network West or hospital staff, physicians, health professionals, and members of the public for educational, treatment, research, scientific, public relations, marketing, news media, and charitable purposes. 

     I warrant that I am over the age of eighteen (18) and otherwise authorized to release the use of photographs, video and/or information regarding the donation, recovery and/or transplant of organs and/or tissues to Donor Network West for the permitted uses.  I authorize the use or disclosure of such photographs, videos and/or information in order to assist scientific, treatment, educational, public relations, marketing, news media, and charitable goals, and I hereby waive any right to compensation for such uses by reason of the foregoing authorization.  I and my successors or assigns hereby hold Donor Network West, its employees, officers and agents, and their successors and assigns harmless from and against any claim for injury or compensation resulting from the activities authorized by this agreement. 

     I may rescind this Authorization up until a reasonable time before any photographs, video or information are used, but I must do so in writing and submit it to:  Donor Network West, 12667 Alcosta Blvd. Suite 500 San Ramon, CA 94583. 

     I have a right to receive a copy of this Authorization. 

     Information disclosed pursuant to this Authorization could be re-disclosed by the recipient.  Such re-disclosure is in some cases not protected by California law and may no longer be protected by federal confidentiality law (HIPAA).