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Voluntary Assumption of Risk and Waiver of Liability Relating to COVID-19

This waiver and declaration must be completed prior to or upon visiting the Township of Brock and before participating in any activity organized by or provided through the Township of Brock.

The novel coronavirus (COVID-19) has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is known to spread mainly by contact from person to person. Consequently, local, provincial and federal governmental authorities recommend various measures in order to reduce the spread of the virus.

The Township of Brock and its members commit themselves to complying with the requirements and recommendations of federal, provincial and local public health agencies and other governmental authorities. The Township of Brock is also committed to implementing and adopting all necessary measures to reduce and/or eliminate the spread of COVID-19 in its facilities. However, the Township of Brock cannot guarantee that you, your child (if participant is a minor), or any person you are the tutor or legal guardian of (“Participant”) will not become infected with COVID-19. Further, attending activities at the Township of Brock could increase a Participant’s risk of contracting COVID-19, despite all preventative measures put in place by the Township of Brock.

By signing this document:

  • I acknowledge that as a Participant, participating in activities or events organized by or provided through the Township of Brock may present various elements of risk including the risk of exposure to COVID-19. As a Participant, I understand and voluntarily assume any and all risk of exposure to COVID-19 that I and/or my child, tutor or legal guardian could be exposed to or infected by COVID-19 by participant in the Township of Brock’s activities. I understand that being exposed to or infected by COVID-19 may lead to personal injury, illness and/or death.
  • I declare that I and/or my child, tutor or legal guardian are participating voluntarily in the Township of Brock’s activities.
  • I declare that neither myself nor my child, tutor, legal guardian nor anyone in my household, have experienced cold or flu-like symptoms in the last 14 days (including fever, cough, sore throat, respiratory illness, difficulty breathing.
  • I agree that if I and/or my child, tutor, legal guardian or anyone in my household experiences any cold or flu-like symptoms after signing this waiver we will not attend any of Township of Brock’s activities, programs, services or facilities until at least 14 days have passed since those symptoms were last experienced.
  • I confirm that neither myself, my child, tutor, legal guardian nor any person in my household have travelled to or had a lay-over in any country outside of Canada, or in any Canadian province, in the past 14 days. I agree that if myself, my child, tutor, legal guardian or any person in my household travels, outside the Province of Ontario after submitting this waiver, I will immediately notify the Township of Brock of said travel and not attend any of the Township of Brock’s activities, programs or services until at least 14 days have passed since the date of return.
  • I, my child, tutor and/or legal guardian agree to the requirements and recommendations of the federal, provincial and local public health agencies and other governmental authorities and to those special safety regulations put in place by the Township of Brock as it pertains too COVID-19 and agree to adopt all necessary measures to those effects, including maintaining appropriate physical distancing and wearing appropriate personal protective equipment including gloves and face masks, as required.
  • I, my child, tutor and/or legal guardian agree that, by signing this waiver and agreeing to the terms and conditions set out in, I agree to release, forever discharge, waive, save harmless, defend, protect and keep indemnified the Township of Brock and all of its respective agents, employees and representatives from and against any and all kinds of actions, claims, costs, expenses and demands in respect of death, injury, loss or damage, to my person or property or persons who might claim through me, however caused, including any negligence on the part of the Township of Brock, arising out being permitted to attend at or participate in Township of Brock activities.

This document will remain in effect until the Township of Brock, as per the direction of the federal, provincial and local government and health officials, determines that the acknowledgements in this declaration are no longer required.

This document supplements but does not replace any other Township of Brock waivers previously signed.

The person signing this form acknowledges that they are at least eighteen (18) years of age and are legally authorized and capable and have read the above and understand that in participating in any program offered and/or attending the Township of Brock, the participant and/or their parent or guardian is assuming the risk associated with doing so.

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    Township of Brock

    1 Cameron Street East

    PO Box 10

    Cannington ON L0E 1E0

    Phone: 705-432-2355

    Toll-free phone: 1-866-223-7668

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