RELEASE AND WAIVER. In consideration of my receiving services from Genesis Hopeful Haven I, being 18 years of age or older, or the guardian of a youth under the age of 18 do hereby forever release, waive, discharge, and covenant not to sue and its past, current, and future officers, directors, employees, members, volunteers, contractors, representatives, parents, owners, affiliates, agents, successors, and assigns GHH from any and all damages, injuries, losses, liability, claims, causes of action, litigation, or demands, including but not limited to those for personal injury, sickness, or death, as well as property damages and expenses, of any nature whatsoever which may be incurred, directly or indirectly, now or in the future, in any way related to COVID-19 and in connection with my participation in the Services or any travel related thereto. I promise not to sue GHH for any of the foregoing. ASSUMPTION OF RISKS. I understand that while GHH has undertaken reasonable steps to lessen the risk of transmission of COVID-19 in connection with the Services, GHH is not responsible in any manner for any risks related to COVID-19 in connection with the Services. Furthermore, I represent and warrant that I or participating youth do not suffer from any medical condition or disease that might in any way hinder or prevent me from receiving the Services, including, to my knowledge, COVID-19. This Agreement contains the entire understanding of the parties relating to the subject matter, and shall not be altered, modified, amended, waived or supplemented in any manner whatsoever except by a written agreement signed by both parties here to or their duly authorized representatives.

Print name of participating youth

Print name of participant age 18 or over

Is youth partially or fully vaccinated -

/ if partially when is second shot due

Signature of Parent/Guardian/Caregiver

Are you partially or fully vaccinated -

/ if partially when is 2nd shot due