Covid-19 Waiver for In-Person Events Form

Bay Area Moreno Institute

Sylvia Israel LMFT, RDT/BCT, TEP

Covid-19 Waiver for In-Person Events Form

Title of Event:  Practicing Self-Compassion with Psychodrama

To participate in this in-person Bay Area Moreno Institute (BAMI) event, please acknowledge and accept the following:

• I voluntarily participate in this in-person BAMI event and acknowledge that I will follow all set practices to promote health and reduce the spread of illness while participating in this event.

• I have tested negative to the COVID-19 virus within 48 hours of the workshop.

• I am not currently experiencing any Covid-like symptoms of illness, such as (new symptoms of) shortness of breath or difficulty breathing, fever, chills, muscle pain, headache, sore throat or loss of taste or smell.

• As far as I know, I have not been exposed to someone diagnosed with the Coronavirus/Covid-19 variants in the last 14 days.

I hereby release BAMI harmless from any damages caused by any act, or failure to act, on the part of BAMI or its principal or associates.

I understand this release discharges BAMI from any liability or claim I may have with respect to any bodily injury, illness, death or medical treatment that may arise from, or in connection with, the BAMI event.

Name (print):

Signature (electronic accepted):

Date: