LBA Family Waiver
All families are required to sign and submit this waiver before returning to LBA for the 2020-21 school year. If possible, please submit this waiver by August 1, 2020 so we can adequately prepare for our return to school. If your preferences change after submitting this waiver, please submit a new waiver to indicate your new preferences.

For additional details about LBA's 2020-21 Return to School, visit http://go.lba.fyi/return. Thank you!
Sign in to Google to save your progress. Learn more
Email *
Student Full Name(s) and Grade(s) *
Student Face Covering Policy
LBA’s Face Covering Policy is in compliance with federal, state, and local government requirements and recommendations and will be updated as those requirements change. Currently, face coverings are required for all students in grades K-12 who do not have a medical condition or disability, per order of the Governor of Ohio. To qualify for the medical/disability exemption, a family must provide the office with a doctor’s note. Face coverings may be removed, with permission, while actively eating or drinking or actively exercising or playing sports (i.e. recess). For updates, please visit http://go.lba.fyi/return.

Regardless of the ages of your student(s), please indicate your face covering preference below. LBA will do its best to accommodate family preferences when they don't conflict with federal, state, local, and school requirements and recommendations.
Face Coverings Preference *
Additional Comments/Questions
Waiver of Liability and Acceptance of Terms and Conditions for Participation at Liberty Bible Academy
Liberty Bible Academy (LBA) is hereby providing notice to me/us that it currently intends to open its educational and school program for the 2020-21 school year.  I/we understand that LBA cannot protect my child and/or me from risks which may be encountered as a result of my child attending LBA. I/we realize there are natural, mechanical, and environmental conditions and hazards which independently or in combination with any activities engaged in while participating in this program may result in the exposure to certain risks including exposure to coronavirus (COVID-19), or other biological agents, virus or similar bacteriological agents, and the risk of being quarantined, or illness that may result in medical care, hospitalization or death.  

I/we hereby state that I, on behalf of my child and myself, am an adult, over the age of 18, and legally competent to sign this form. I/we understand these inherent risks and dangers involved with participation in the school providing its educational program and acknowledge the existence of risks which are not obvious or predictable, and hereby intend this release to extend to injury or loss which results from both obvious or predictable risks, as well as risks that are unpredictable and not obvious and to extend to myself and my child, as applicable.

I/we agree to keep my child home from school if he/she has a fever of 100 degrees Fahrenheit or if he/she exhibits other symptoms of COVID-19, including cough, shortness of breath, difficulty breathing, chills, rigors, myalgia, headache, sore throat, new loss of taste or smell, nausea, vomiting, or diarrhea. I agree to keep my child home until symptom free for 24 hours. If my child has been directly exposed to or in contact with someone who has tested positive for COVID-19, I agree to keep that child home for a 14 day quarantine period. I agree to comply with federal, state, local, and school travel advisory requirements if my child returns from travel to countries, states, and municipalities with an existing travel advisory. If my child tests positive for COVID-19, I agree to isolate that child for 14 days and submit a negative COVID-19 test to LBA at the end of that time period. I/we understand that no person who has tested positive will be permitted to return to school without verification of a subsequent negative COVID-19 test result.

I/we understand that LBA staff will enforce protocols but cannot guarantee compliance with specific social distance requirements, face covering usage, hygiene practices, cleaning protocols, visitor behavior, testing and symptom checks, quarantine periods, or other health and safety recommendations. I also understand that specific guidelines and enforcement may change as federal, state, and local recommendations and requirements change.

In consideration of myself and my child participating LBA's educational and school program,  I/we, and any legal representatives, heirs and assigns, hereby release, waive, and discharge LBA, its officers, directors, employees, agents, and representatives from any and all liability for any and all loss or damage, and any claim or damages resulting therefrom, on account of any injury, illness or exposure to and/or contracting the coronavirus (COVID-19) or other biological agents, virus or similar bacteriological agent by me or my child's attendance at and participation in LBA's educational program, including any medical expenses, injury and/or death.

I/we agree to indemnify LBA, its officers, directors, employees, agents, and representatives from any loss, liability, damage, or cost that may be incurred due to my child/student’s participation in the aforementioned program, whether caused by negligence of LBA, or otherwise, with the exception for gross negligence of the ministry. I fully understand, on my own behalf and on behalf of my child the risks associated with the aforementioned participation and assume any risk associated therewith.

This notice, release and indemnity agreement contains the entire agreement between and among the parties hereto, and the terms of this release are contractual and not a mere recital. The parties to this agreement hereby agree that the interpretation and enforceability of this release shall be governed by the laws of the State of Ohio.

I /we expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by applicable laws, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I/we understand that by signing this agreement I am giving up on behalf of my child and myself certain legal rights and remedies including the right for my child and/or myself to recover damages in the event of death, personal and/or bodily injury of any kind, property loss or damage of any nature whatsoever including attorney's fees, and other losses that my child or that I may sustain in association with my child’s participation in LBA's educational program.

I/we have carefully read the foregoing release and know and understand the contents thereof, I/we sign this release voluntarily as my own free act with full knowledge of its significance, intending to be legally bound thereby.
Untitled Title
Please sign this document by typing in your name below.
Parent/Guardian Name(s) *
Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Liberty Bible Academy. Report Abuse