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Covid 19 Waiver

Girl Scouts of Hawaii requires a signed Agreement for each minor and adult participant prior to in-person participation with Girl Scouts.  Girl Scouts of Hawai`i has been closely monitoring information on our COVID-19 information page with updates from the Centers for Disease Control, the World Health Organization, and the local public health departments for our counties within our council. We will continue to update our website frequently with new messaging as state officials provide updates.

For screening guidelines please see our COVID-19 Screening Guide.

ASSUMPTION OF RISK, RELEASE, AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19

A separate form is required for each participant, please do not submit multiple individuals on the same form.  Forms that are incomplete or have erroneous submissions will be rejected and a new form will be required to participate in Girl Scouts in-person events/programs/activities

Your submission of this form will be considered applicable to Membership Year 2022, starting October 1, 2021. A new form is required for each participant for Membership Year 2022.

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 Youth Member
 Adult Member
 Youth Non-Member
 Adult Non-Member
For an Adult Participant:
 
 
For a Minor Participant (under 18):

Only include youth details if the form applies to a youth.  Adults should not include the youth's name on their submissions.

 
 
 

I HAVE REVIEWED AND HAVE SIGNED THIS AGREEMENT so that I and/or my children listed below will be permitted to participate in, visit or utilize the facilities, services, and/or the programs of Girl Scouts of Hawaii, a Hawaii nonprofit corporation (“Council”), including, but not limited to, troop meetings and events, Service Unit activities and events, Council activities and events (whether on Council’s site or a third party site), use of Council property, and participation in Council camps. If a third party is involved in providing services or a facility, that third party may require an additional release.

I understand that:

  • Novel coronavirus (‘‘COVID-19”) infections have been confirmed throughout the United States, including multiple cases in my area.
  • COVID-19 is an extremely contagious virus that spreads easily, including through person-to-person contact.
  • As with any social activity, use of Council facilities or services, or participation inCouncil programs, may present the risk of contracting COVID-19. While Council takes safety and preventative precautions, Council can in no way warrant that COVID-19infection will not occur through the use of such facilities or services or participation council programs.

I agree to comply and to ensure compliance by my children with the most recent guidance and recommendations issued by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and my local state agency or municipality for slowing the transmission of COVID-19. I agree that neither I nor my participating children shall visit or utilize the facilities, services, and/or programs of Council within 14 days after (i) returning from highly-impacted areas subject to a CDC Level 3 Travel Health Notice, (ii) exposure to any person returning from areas subject to a CDC Level 3 Travel Health Notice, (iii) exposure to any person who has a suspected or confirmed case of COVID-19, or (iv) exposure to any other risk identified by the most recent guidelines or recommendations or guidelines situation delineated by WHO, the CDC or my state public health agency or municipality. I further agree that neither I nor my participating children shall participate in, visit or utilize the facilities, services, and/or programs of Council if I, he, or she (i) experience(s) symptoms of COVID- 19, including, without limitation, fever, cough, loss of sense of taste or smell, or shortness of breath, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. I agree to notify Council immediately if I believe that any of the foregoing access/use restrictions may apply.

I acknowledge that Council has taken certain steps to implement certain recommended guidance and recommendations issued by public health agencies for hindering the transmission of COVID-19, including, without limitation, the access/use restrictions set forth above. I agree that Council may revise its procedures at any time based on updated recommended guidance and recommendations.

TO COVID-19 AT ANY COUNCIL FACILITY OR DURING PARTICIPATION IN ANY PROGRAM OR ACTIVITY AND ANY ILLNESS, INJURY OR DEATH RESULTING THEREFROM.

THE SIGNER AGREES THAT THIS RELEASE AND WAIVER SHALL FULLY DEFEND, INDEMNIFY, AND HOLD HARMLESS GIRL SCOUTS OF HAWAI`I AND GIRL SCOUTS OF THE USA FROM ANY AND ALL CLAIMS, LAWSUITS, DEMANDS, CAUSES OF ACTION, LIABILITY, LOSS, DAMAGE AND/OR INJURY, OF ANY KIND WHATSOEVER (INCLUDING WITHOUT LIMITATION ALL CLAIMS FOR MONETARY LOSS, PROPERTY DAMAGE, EQUITABLE RELIEF, PERSONAL INJURY AND/OR WRONGFUL DEATH) RELATING TO COVD-19, WHETHER BROUGHT BY AN INDIVIDUAL OR OTHER ENTITY OR IMPOSED BY A COURT OF LAW OR BY ADMINISTRATIVE ACTION OF ANY FEDERAL, STATE OR LOCAL GOVERNMENT BODY OR AGENCY, ARISING OUT OF, IN ANY WAY WHATSOEVER, ANY ACTS ON THE PART OF GIRL SCOUTS OF HAWAI`I, GIRL SCOUTS OF THE USA, ITS OFFICERS, OWNERS, PERSONNEL, EMPLOYEES, AGENTS, CONTRACTORS, INVITEES, OR VOLUNTEERS. THIS INDEMNIFICATION APPLIES TO AND INCLUDES, WITHOUT LIMITATION THE PAYMENT OF ALL PENALTIES, FINES, JUDGMENTS, AWARDS, DECREES, ATTORNEY’S FEES, AND RELATED COSTS OR EXPENSES.

I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF ALL CLAIMS. IF SIGNING ON BEHALF OF MINOR: I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON BEHALF OF MY PARTICIPATING MINOR CHILD(REN) AND/OR LEGAL WARDS, AND I REPRESENT AND WARRANT TO COUNCIL THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S).

Youth Parent/Caregiver Signature for youth under the age of 18 or Adult signature for (self).

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By selecting "Submit" you consent to be legally bound by this Agreement's terms and conditions.

 
 

Unless otherwise authorized by Power of Attorney or court order, individuals over the age of 18 must complete and sign the form for themselves.  If you are submitting this form on behalf of someone else, please provide supporting documentation to authorize this act to Girl Scouts of Hawai`i via email to Customer Care.  Submission of this form is your agreement to an electronic signature, if you wish to provide a “wet” signature please download this form and submit to Customer Care