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Assumption of Risk for Unaccompanied Minors

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  7. Instructions
    Unaccompanied minors (age 14-17) using the facility without a parent/guardian must have a valid assumption of risk form completed, signed/dated, and submitted by a parent/guardian within 24 hours of arrival. The questionnaire must be submitted separately each visit.
  9. ASSUMPTION OF RISK AGREEMENT FOR COMMUNICABLE DISEASES INCLUDING COVID-19
    In consideration of being allowed to use the Amenities and Facilities* owned and operated by the Willowsford Homeowners Association, Inc. (“Association”), I acknowledge, appreciate, and agree that:
  11. 1)
    My use of the Amenity owned by the Willowsford Homeowners Association, Inc. includes possible exposure to and illness from various bacterial and viral infectious diseases including but not limited to influenza and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist, and cannot be entirely eliminated; and,
  13. 2)
    I hereby acknowledge that notwithstanding the Association’s performance of all obligations established by Executive Order or otherwise, including, but not limited to, any Guidelines issued by the Commonwealth of Virginia, Center for Disease Control, or otherwise, the use of the Amenity carries with it inherent risk, and that it is not possible for the Association to completely prevent the presence of or eradicate from the Association’s facilities and other facilities under its various bacterial and viral infectious diseases including but not limited to influenza and COVID-19, and I may be exposed to such diseases due to my use of the Amenity.
  15. 3)
    I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS associated with the use of the Amenity, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE ASSOCIATION OR ITS DIRECTORS, OFFICERS, AGENTS EMPLOYEES, VOLUNTEERS OR CONTRACTORS, or others, and assume full responsibility for my use of the Amenity, and,
  17. 4)
    I willingly agree to comply with all rules adopted by the Association from time to time related to the use of the Willowsford Amenities and Facilities, including those intended to reduce the risk of incurrence of infectious diseases. I also agree that I shall comply in all respects with all Orders issued by the Commonwealth of Virginia and Loudoun County, including, but not limited to, all Orders governing the use of masks at a swimming pool and outdoors, and that my right to use the Swimming Pool is contingent upon my compliance with all rules adopted by the Association and all Orders issued by the Commonwealth of Virginia or Loudoun County. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest staff member immediately; and,
  19. 5)
    I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY AGREE TO RELEASE, INDEMNIFY, HOLD HARMLESS AND COVENANT NOT TO SUE OR OTHERWISE PURSUE ANY LEGAL ACTION against the Willowsford Homeowners Association, and its officers, directors, officials, agents, contractors, including, but not limited to, Premier Aquatics and/or employees, (individually and collectively “ASSOCIATION PARTIES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property in connection with my use of the Amenity, WHETHER ARISING FROM THE NEGLIGENCE OF ASSOCIATION PARTIES OR OTHERWISE, to the fullest extent permitted by law.
  21. 6)
    A minor(s) for whom I am responsible, is not currently experiencing fever (100.4 degrees Fahrenheit or higher) and does not have a sense of having a fever, does not currently have a new cough that cannot be attributed to another health condition, does not currently have any new shortness of breath that cannot be attributed to another health condition, does not currently have any new chills that cannot be attributed to another health condition, does not currently have a new sore throat that cannot be attributed to another health condition, and does not currently have any new muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise).
  23. 7)
    This is to certify that I, as parent/guardian, with legal responsibility for the participant identified above, have read and explained the provisions in this document to my child/ward, including the risks of use of the Amenity, and his/her personal responsibilities for adhering to rules adopted by the Willowsford Homeowners Association, Inc., related to risks of use of the Amenity, including those intended for protection against communicable diseases, and that such diseases may be contracted even if such rules are followed. Furthermore, my child/ward understands and accepts and assumes these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her COVENANT NOT TO SUE OR OTHERWISE PURSUE ANY LEGAL ACTION provided above against all the Association Parties and myself, my spouse, and child/ward do hereby COVENANT NOT TO SUE OR OTHERWISE PURSUE ANY LEGAL ACTION against any and all Association Parties, for any and all liabilities or claims incident to my minor child’s/ risks of use of the Amenity as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE ASSOCIATION PARTIES, to the fullest extent provided by law. In addition, on behalf of myself, my spouse and my child(children)/ward(s), I assume the risk of myself, my spouse, and my child/ward contracting communicable disease due to the risks of use of the Amenity. I further warrant and represent that my child’s responses to the health screening questions 1-6 above are true and accurate.
  25. *Includes all Willowsford property, amenities, and facilities including, but not limited to The Lodge facility, pools, and fitness center, Sycamore House facility and pools, Willow Grove Splash Park, and all other amenities, and property.
  27. I HAVE READ THIS HEALTH SCREENING FORM AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY, UNDERSTANDING THAT EXECUTION OF THIS AGREEMENT IS A CONDITION TO MY USE OF THE AMENITY.
    30. Leave This Blank:

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