DECLARATION — COVID-19 EXPOSURE 

I make the following statements, which are true and correct to the best of my knowledge:

  • I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, headache, sore throat, or sudden loss of taste or smell.
  • I have not been exposed to a person with a suspected or confirmed case of COVID-19, or, I work in a health care facility and have properly used "personal protective equipment" (PPE) at all times while working with patients, or if I have been exposed to a person with COVID-19, I have observed and completed quarantine in accordance with CDC quarantine guidance.
  • I have not been diagnosed with COVID-19 or if I have been diagnosed with COVID-19, I have been released from isolation in accordance with CDC isolation guidance.
  • I am following all CDC-recommended guidelines as completely as possible in order to limit my exposure to COVID-19 and the spread of COVID-19. *:
I affirm that I make the statements in the Declaration, above, and that they are true and correct to the best of my knowledge. *

DECLARATION — RECENT TRAVEL

  • I have not traveled outside the United States in the last 10 days; or if I have traveled internationally, I have completed the required testing or quarantine protocol in accordance with CDC international travel requirements.
I affirm that I make the statements in the RECENT TRAVEL, above, and that they are true and correct to the best of my knowledge. *

AGREEMENTS 

Please read and affirm the following health and safety protocols. We’ve put these in place to help KEEP EVERYONE AS SAFE AS POSSIBLE.

  • I understand that masks are required for all persons over the age of two (2) years old for entry to any NDMU event. Individuals not wearing a mask will be refused entry unless they provide reasonable evidence of a bona fide disability or medical condition.. PLEASE BE SURE TO BRING A MASK TO THE EVENT--IT IS REQUIRED FOR ENTRY
  • I agree to wear a mask at all times while attending any NDMU event.
  • I understand that I may only remove my mask when seated at a table for dining.
  • I agree to follow physical distancing guidelines at all times.

THESE RULES ARE FOR YOUR SAFETY AND THE SAFETY OF OTHERS*:

I understand and agree to comply with all of the above during my attendance at any NDMU event. *

NOTRE DAME OF MARYLAND UNIVERSITY CORONAVIRUS/COVID-19 WARNING, ASSUMPTION OF RISK, AND WAIVER

I hereby acknowledge that the coronavirus COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. I acknowledge that by attending the above event or accessing NDMU’s facilities, I could increase my risk of contracting COVID-19. I understand and agree that neither NDMU nor SAGE Dining Services in any way warrants that COVID-19 infection will not occur through my attendance at the above event or by accessing NDMU’s facilities. I hereby voluntarily seek to attend the above event and acknowledge that my actions may increase my risk of exposure to the coronavirus COVID-19. I accept the risk and release and agree to hold harmless NDMU and/or SAGE Dining, the employees, directors, officers, and agents of either of them, and the heirs, successors, and assigns of any of them, from any and all claims that may arise from or relate to my attendance at the above event or my use of NDMU’s facilities, including any claims concerning exposure to the coronavirus COVID-19 and any resulting harm or injury, including permanent disability and death. I acknowledge and agree that during my attendance at the above event, I will comply with all procedures designed to reduce the spread of COVID-19.*:

I acknowledge that I understand, accept, and affirm the information in the statements above. *

INFORMATION PRIVACY

I agree that information submitted via this form may be shared with any state agencies, as needed, for the purpose of covid-19 related contact tracing, should it become necessary. I also agree that information submitted via this form will be stored temporarily by NDMU, until it is no longer required as part of our ongoing covid-19 health protocols.*:

Yes I agree. *
If Attendee is under 18 years of age, parent signature is required.