COVID-19 Self-Screening Questionnaire

COVID-19 Self-Screening Questionnaire

Please complete this waiver and questionnaire prior to attending any on-site Pequot Library program.

Pequot Library COVID-19 Program/Event Attendees Waiver
COVID-19, has been declared a worldwide pandemic by the World Health Organization and is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and wearing face masks/coverings when in close contact with others.

Pequot Library Association has put in place preventative measures to reduce the spread of COVID-19; however, it cannot guarantee that you will not become infected with COVID-19. Further, attending an event or program at Pequot Library Association or on its grounds could increase your risk of contracting COVID-19. By registering for or purchasing a ticket to an event or program at Pequot Library Association, you acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you may be exposed to or become infected by COVID-19 and that such exposure or infection may result in personal injury, illness, permanent disability, and death.

You understand that the risk of becoming exposed to or infected by COVID-19 at Pequot Library Association may result from the actions, omissions, or negligence of yourself and others, including, but not limited to, Pequot Library Association employees, volunteers, and program participants and their families. You voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to yourself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that you may experience or incur in connection with your attendance at Pequot Library Association or participation in Pequot Library Association programming (“claims”).

You hereby release, covenant not to sue, discharge, and hold harmless Pequot Library Association, its employees, agents, and representatives, of and from claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of Pequot Library Association, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Pequot Library Association program.

COVID-19 Questionnaire

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