By signing below, I understand that I represent to the West Virginia Balance of State Continuum of Care (WV BoS CoC), and that I am over the age of 18. I hereby agree to hold harmless and release the WV BoS CoC; its member organizations, their boards/trustees, employees, volunteers, count organizers; and other participants in the West Virginia Balance of State Continuum of Care Point-In-Time Count 2021 from any liability for any accident, injury, or death, or any theft or loss of property arising from the participation as a Volunteer in the Point-In-Time Count, regardless of whether incurred as a result of negligence or other. including any COVID-19 related illness or condition (whether infection occurs before, during, or after participation in the Program). I voluntarily assume these and any other risks in participating in the count, and waive all claims and causes of action that may arise out of participation in the count.
I understand that there are additional health risks due to the novel coronavirus, COVID-19, which is extremely contagious and believed to spread primarily from person-to-person contact. Having full knowledge of these risks, I voluntarily assume the risk that I may be exposed to or infected by COVID-19 by my voluntary participation in the Point-In-Time Count, and that such exposure or infection may result in personal injury, illness, disability, and death, as well as transmission of COVID-19 to other individuals. I agree to follow federal, state and county public health guidelines while conducting the Point-in-Time Count and participating in any forms of associated Point-in-Time activities. I further agree to self-monitor for signs and symptoms of COVID-19, and to notify the Continuum of Care if I experience symptoms within 14 days after conducting the Point-in-Time Count.
I have agreed to serve as a volunteer for the West Virginia BoS CoC Point-In-Time Count 2020. I understand that as a volunteer for the WV BoS CoC Point-In-Time Count it will be necessary for me to handle and process confidential information. I acknowledge that I will keep all information confidential while a volunteer and that it is my responsibility to keep this information confidential even after I end my volunteer duties for the WV BoS CoC Point-In-Time Count. I understand that I am not to disclose any identifying confidential information and/or records or to engage in casual or informal conversation identifying any individual involved in the count.
I have read and fully comprehend the information pertained in this form and agree to the terms of this release. By signing below, I acknowledge that it is my responsibility to comply with all relevant laws, policies, and regulations concerning access, use, maintenance and disclosure of information made available to me as a volunteer in the 2021 West Virginia Balance of State Continuum of Care Point-In-Time Count.