WAIVER AND RELEASE OF LIABILITY (Family)


PLEASE READ CAREFULLY BEFORE SIGNING

As you know, due to the COVID-19 pandemic, the Illinois Department of Public Health and the Centers for Medicare and Medicaid have prohibited nursing homes, assisted living facilities, and other health care providers from allowing any visitors into their buildings. IDPH and the CDC are now relaxing those rules to enable outdoor visits with certain restrictions. Bayside Terrace, LLC ("Facility") is allowing you to visit your relative/friend with those restrictions in place but requires that you sign this "Waiver and Release" before doing so.

By signing where indicated, you acknowledge that you are aware that by visiting with a resident at the Facility, you run a risk of contracting the novel coronavirus COVID-19 or other infectious diseases. You expressly assume responsibility for any illness you may incur as a result of your visit to the Facility. You have completed the prescreening questions within 24 hours of your visit and upon arrival at the Facility. You agree that you have answered all questions posed truthfully. You agree that you are competent and able to make health care and personal decisions for yourself.

You agree to waive any, and all claims, known or unknown, of every kind that you have or may have in the future or which any of my heirs, guardians, legal representatives, successors, assigns or any other person or entity acting or purporting to act on my behalf ("the Releasing Parties") have or may in the future have against the Facility, its employees, officers, owners, successors, agents, assignees, affiliates, or any of them ("the Released Parties"). The Releasing Parties understand that this means that the Releasing Parties can never bring any civil, criminal, administrative or other complaints, charge or lawsuit of any kind against the Released Parties and that the Released Parties may use this document as a complete defense against any such complaints, charges or lawsuits brought by the Releasing Parties If the Released Parties incur any attorneys' fees or costs in asserting its rights under this Waiver and Release of Liability, the Releasing Parties will reimburse the Released Parties for such attorney fees and/or costs.

The Releasing Parties also understand that normally, the law normally prohibits the waiver of unknown claims. The Releasing Parties recognize, however, that the very nature of this document contemplates their waiving unknown, future claims. The Releasing Parties represent that they want to waive such unknown claims and that they have had a sufficient opportunity to consult with an attorney of their choice before signing this document.

By signing this Waiver and Release of Liability, you acknowledge that you have fully read and understood everything contained here. This waiver form is valid for one year from the date of signature unless canceled by written notice.


Name of the resident who you are visiting:  

Today's Date: 2020-09-27

Leave this empty:

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Bayside Terrace, LLC https://forms.btwaukegan.us
Signature Certificate
Document name: WAIVER AND RELEASE OF LIABILITY (Family)
lock iconUnique Document ID: 5df1ba37192e95cf3774abc0ccbd9116a154040b
Timestamp Audit
2020-07-27 20:17 CDTWAIVER AND RELEASE OF LIABILITY (Family) Uploaded by Jeffrey Parrish - [email protected] IP 10.2.0.146
2020-07-27 20:25 CDTJeff Parrish - [email protected] added by Jeffrey Parrish - [email protected] as a CC'd Recipient Ip: 172.16.0.198
2020-07-27 20:38 CDTBayside Visits - [email protected] added by Jeffrey Parrish - [email protected] as a CC'd Recipient Ip: 172.16.0.198
2020-07-27 20:42 CDTBayside Visits - [email protected] added by Jeffrey Parrish - [email protected] as a CC'd Recipient Ip: 172.16.0.198
2020-07-28 08:48 CDTBayside Visits - [email protected] added by Jeffrey Parrish - [email protected] as a CC'd Recipient Ip: 10.2.0.146