Farm of Peace COVID-19 Policy and Liability Release Waiver

The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which The Farm of Peace, Sufi Center East will observe.

 

We welcome you to the Farm of Peace. We are glad to be able to host our community, guests, and staff in as safe of a way as possible. To limit the risk of virus transmission and ensure your safety and the safety of others, we are asking everyone who comes to the Farm property to follow a series of health and safety protocols.

 

For guests and visitors coming to the Farm from off of the property, we ask you to please observe the following prior to arrival: 

  • Please stay home if:
    • You are sick or experiencing symptoms such as cough, fever, shortness of breath, fatigue or other symptoms related to covid-19 or other communicable diseases or if you have experienced any of these symptoms in the last 14 days.
    • You or a member of your household have been diagnosed with covid-19 within the last 30 days
    • You or a member of your household have traveled internationally the last 30 days or visited an area of the US that is highly affected with covid-19 in the last 30 days
  • Prior to your arrival, we will ask everyone living beyond a 20 mile radius of the Farm to complete a screening over the phone with a member of our staff to assess your risk-level together.
  • We ask everyone who enters and uses the IPC Building to please:
    • Wear a mask in public spaces and when interacting with others who are not in your household
    • Wash your hands upon entering the building 
    • Complete a daily temperature check with a member of our staff to ensure your temperature is below 100.3 degrees Fahrenheit
    • Wash your hands before using the kitchen 
    • Complete a Covid-19 waiver form

Other Guidelines:

  • To ensure limited group density in indoor spaces, please maintain a limit of 6 people in the IPC dome room, 5 people in the IPC dining room, and 40 people in the teaching barn. 
  • Please wear a mask when interacting with others not in your household in all public spaces on the Farm. 
  • Please also maintain 6 foot distancing wherever possible.
  • Please use hand sanitizer upon entering the teaching barn 
  • If you are diagnosed with covid-19 within 21 days after visiting the Farm, please contact us to let us know.
  • Please know that we are unfortunately not able to accommodate guests who become sick with covid-19 symptoms while at the Farm. If you become sick with symptoms while you are on Farm of Peace property you will be asked to leave and quarantine elsewhere.

In consideration of participation in any activity at the Farm of Peace Sufi Center East, the undersigned acknowledges and agrees to the following: 

(initial)____ I have not experienced symptoms of fever, fatigue, difficulty in breathing, or dry cough, loss of taste and/or smell, or any other symptoms relating to COVID-19 or any other communicable disease within the last 14 days.

(initial)____ I have not, nor have any member(s) of my household, traveled by sea or by air, internationally within the past 30 days. 

(initial)____ I have not, nor has any member of my household, visited an area within the United States that was reported to be highly affected by COVID-19, within the last 30 days.

(initial)____ I have not, nor has any member(s) of my household, been diagnosed with the COVID-19 virus within the last 30 days.

(initial)____ I hereby agree to follow Center of Disease Control (CDC) and local health district guidelines and Sufi Center East policies and procedures for social distancing to reduce the spread of Novel Coronavirus, or COVID-19. This will require me to maintain six (6) feet of distance with anyone I encounter including guests, staff, volunteers, and community members as much as possible. This procedure will be required for visitor-to-visitor contact as well to limit exposure.

(initial)____ I agree to utilize surgical masks or improvised masks such as scarves, bandanas and handkerchiefs to reduce the risk of exposure to myself and others. I agree to wash or sanitize my hands after using the restroom, sneezing, coughing and before preparing and/or eating meals.

(initial)____ I understand Sufi Center East is not responsible for any potential exposure to Novel Coronavirus, or COVID-19, which is not a direct result of negligence on the part of their employees, volunteers, or the organization. Unless specifically stated in writing, I understand that there is no Pennsylvania State Labor and Industries employment security insurance provided to me, nor is there any direct medical health coverage afforded to me during my relationship with Sufi Center East/ Farm of Peace.

(initial)____ I acknowledge that my presence at the Farm of Peace location and participation in any activity of the organization may cause injury or illness such as, but not limited to, Influenza, MRSA, or COVID-19 which may lead to paralysis or death.

 

Following the pronouncements above I hereby declare the following:

(initial)____ I am fully and personally responsible for my own safety and actions during my participation and I recognize that I may in any case be at risk of contracting COVID-19.

(initial) ____With full knowledge of the risks involved, I hereby release, waive, discharge the Sufi Center East, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me, related to COVID-19, while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.

(initial)____ I agree to indemnify, defend, and hold harmless the Sufi Center East from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released parties due to injury, loss, or death from or related to COVID-19.

By signing below I acknowledge:

  1. I have read the foregoing Liability Release Waiver and understand its contents. 
  2. I am at least eighteen (18) years old and fully competent to give my consent. 
  3. I have been sufficiently informed of the risks involved and give my voluntary consent in signing as my own free act and deed. 
  4. I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.

 

By signing below, I agree to comply with the written instructions above. Failure to comply with these written instructions, or verbal instructions from staff, may result in my volunteer privileges being removed and I may be asked to leave the premises.

 

Participant/ Volunteer/ Employee Printed Name

 

____________________________________________________________

 

Signature

 

____________________________________________________________

 

Date

 

____________________________________________________________

 

Farm of Peace Representative Printed Name

 

____________________________________________________________

 

FOP Representative Signature

 

____________________________________________________________

 

Date

 

____________________________________________________________

 

 

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