HCC COVID 19 Waiver Form

Please fill out this form and click submit.

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. 

I further acknowledge that Houston Chinese Church has put in place preventative measures to avoid the spread of the Coronavirus/COVID-19, if any.

I further acknowledge that Houston Chinese Church cannot guarantee that I will not become infected with the Coronavirus/COVID-19 while I am on church campus/property. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, congregation, staff, and other visitors and their families.

By attending Houston Chinese Church, I voluntarily acknowledge that I must comply with all set procedures to avoid the spread while attending church worship services and all other activities at Houston Chinese Church.

Personal Safety Precautions

I attest that:
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or currently confirmed case of the Coronavirus/COVID-19. 
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as noncontagious by state or local public health authorities.
* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

HCC Release Information

I hereby release and agree to hold Houston Chinese Church harmless from, and waive on behalf of myself, my heirs, and any personal representatives for any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of Houston Chinese Church, or that may otherwise arise in any way in connection with any activities with/at Houston Chinese Church. I understand that this release discharges Houston Chinese Church from any liability or claim that I, my heirs, or any personal representatives may have against Houston Chinese Church with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to Houston Chinese Church caused by COVID-19. I also agree to indemnify and save harmless Houston Chinese Church from any liability or damages, including any attorney’s fees, which may result from attending any Houston Chinese Church’s activities. I further agree that this liability waiver and release extends to Houston Chinese Church with all pastoral teams, church staff, congregations, volunteers, its representatives, trustees, and contract workers.

Please select all that apply.
* By entering my name in the box above, I am providing my digital signature on this form
Minors Liability Release Waiver

By signing below, I as a parent or legal gardian acknowledge that my child and I have read the Liability Release Waiver and understand its contents. I, as a parent or legal gaurdian, give permission and consent for my child to attend Houston Chinese Church. We acknowledge that we have been sufficiently informed of the risks involved and give our voluntary consent in signing this form as our own free act and deed; bound by the same, and free from any inducement or representation.
* By entering my name and my child's name in the box above, we are providing a digital signature on this form


Please fill out this form and click submit.