I, , am offering to volunteer or receive services in the capacity I have decreed in my responses above, henceforth known as "the activity." I understand that by doing so, I put myself at substantial risk to contract illnesses that can be detrimental to my health. I understand and confirm that my participation in the activity is voluntary. I confirm and represent that I am over the age of 18, or if I am not, that my parent or guardian has signed for me. I recognize that there are risks involved in participating in this activity and hereby assume all risks, unknown or known, foreseeable or unforeseeable, of injury, harm, damage, or death in connection with my participation in this activity. I understand and agree that none of the organizations listed as a Network Partner on this website, henceforth known as the "COVID Response Network," nor their trustees, officers, directors, employees, agents or representatives may be held liable in any way for any injury, harm, damage, or death that may occur to me as a result of my participation in this activity and hereby release COVID Response Network, their trustees, officers, directors, employees, agents and representatives from any and all liability for, and waive any claim for, any personal injury, harm, death, economic or noneconomic damages or loss, including attorneys’ fees, in any way connected with my participation in the activity including transportation to an from the activity, even if caused by the negligent acts or omissions or other misconduct of COVID Response Network or any of its trustees, officers, directors, employees, agents and representatives.

I accept personal responsibility for any liability, personal injury, economic or noneconomic damages or loss connected with my participation in the activity. To the fullest extent permitted by law, I agree to indemnify, save and hold harmless (i.e., to reimburse and be responsible for) COVID Response Network, their trustees, officers, directors, employees, agents and representatives from any claim by myself, my estate, heirs, successors, assigns or other persons arising out of my participation in the activity. This waiver shall be binding upon my relatives, personal representatives, heirs, beneficiaries, next of kin, or assigns.

I authorize COVID Response Network through their trustees, officers, directors, employees, agents or representatives to render or obtain such emergency medical care or treatment for me as may be necessary should any injury, harm or accident occur to me while participating in this activity. I authorize COVID Response Network to share my information with their officers, volunteers, and any other party necessary to helping meet the requests made in my entry into this form, or for any research and development opportunity to better help meet my requests in the future.

I understand and acknowledge that COVID Response Network does not provide health or medical insurance in connection with our efforts and I agree that I will be financially responsible for any bills incurred as a result of medical treatment, including emergency medical treatment and/or transportation to a medical facility, in connection with my participation in the activity.

This instrument shall be governed, construed, and enforced in accordance with the law of the State of Michigan.