COVID-19 Health and Safety Information

PARTICIPANT RELEASE AND WAIVER OF LIABILITY AND INDEMNIFICATION AGREEMENT

In consideration of participation in the NICU Leadership Forum at the Naples Grande Beach Resort located in Naples, FL (the “Forum”) sponsored by Synova Associates LLC (“Synova”), all steps to stay safe and uninjured, including, but not limited to compliance with local and CDC Guidelines relative to COVID-19, such as social distancing and wearing face coverings as required by the CDC and local laws and rules to reduce the risks of exposure to COVID 19.

Each participant/volunteer will need to present one of following two options, along with appropriate identification matching the name on all documentation, for entry in the Forum:

1. Proof of a negative PCR COVID-19 test within seventy-two (72) hours of the conference beginning on Monday, November 15th at 8:00am; or
2. Proof of a full COVID-19 vaccination administered at least two (2) weeks prior.

Additionally, because COVID-19 is extremely contagious and is spread mainly from person-to-person contact, Synova has put in place preventative measures to reduce the spread of COVID-19. However, Synova cannot guarantee that anyone in attendance at the Forum will not become infected with COVID-19. In light of the ongoing spread of COVID-19, individuals who fall within any of the categories below should not participate in the Forum and/or other face-to-face activities. By attending the Forum, you certify that you do not fall into any of the following categories:

1. Individuals who currently or within the past fourteen (14) days have experienced any symptoms associated with COVID-19, including fever, cough, and shortness of breath, among others; or
2. Individuals who have traveled at any point in the past fourteen (14) days either internationally or to a community in the U.S. that has experienced or is experiencing sustained community spread of COVID-19 and are not in compliance with current local and CDC Guidelines related to domestic and international travel, as updated (https://www.cdc.gov/coronavirus/2019-ncov/travelers/after-travel-precautions.html); or
3. Individuals who believe that they may have been exposed to a confirmed or suspected case of COVID-19 or who have been diagnosed with COVID-19 and are not yet cleared as non-contagious by state or local public health authorities or the health care team responsible for their treatment.

DUTY TO SELF-MONITOR: You agree to self-monitor for signs and symptoms of COVID-19 (symptoms typically include fever, cough, and shortness of breath) and contact Synova if you test COVID-19 within fourteen (14) days after participating at the Forum.

LIABILITY WAIVER AND RELEASE OF CLAIMS: I acknowledge that I derive personal satisfaction and a benefit by virtue of my participation at the Forum, and I willingly engage in the Forum sponsored by Synova.

RELEASE AND WAIVER. I HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE SYNOVA, ITS PARENTS, SUBSIDIARIES OR OTHER AFFILIATES, OFFICERS, AGENTS, OR EMPLOYEES (“RELEASEES”) FROM ANY AND ALL LIABILITY, CLAIMS, DEMANDS, ACTIONS AND CAUSES OF ACTION OF ANY KIND OR NATURE ARISING OUT OF OR RELATED TO ANY LOSS, DAMAGE OR INJURY, INCLUDING DEATH, THAT I OR ANY OF MY PROPERTY MAY SUSTAIN RESULTING FROM MY PARTICIPATION IN OR IN ANY WAY CONNECTED WITH MY PARTICIPATION IN THE FORUM AND TRAVEL RELATED THERETO, REGARDLESS OF WHETHER SUCH LOSS IS CAUSED BY THE NEGLIGENCE OF THE RELEASEES AND REGARDLESS OF WHETHER SUCH LIABILITY ARISES IN TORT, CONTRACT, STRICT LIABILITY, OR OTHERWISE.

ASSUMPTION OF THE RISK. I acknowledge and understand the following:

1. Participation in the Forum, including travel related thereto, includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and
2. I am fully aware of the current global COVID-19 virus outbreak, the current travel restrictions, and inherent risks involved when choosing to travel, and I knowingly and freely assume all such risks related to travel; and
3. I knowingly and freely assume all such risks related to accidents, mishaps, condition of premises where any and all Forum activity occurs, and illness and infectious diseases, such as COVID-19, even if arising from the negligence or fault of Synova; and
4. It is my responsibility to check the latest travel information regarding the COVID-19 outbreak with the CDC (https://wwwnc.cdc.gov/travel/notices), and applicable state and local governmental agencies of any location that I am traveling to or through, and it is my responsibility to check future travel warnings, travel restrictions, and travel rules, and I accept the risks and consequences of these travel warnings, restrictions, and rules.

MEDICAL ACKNOWLEDGMENT AND RELEASE.  I acknowledge the health risks associated with my participation in the Forum, including but not limited to the condition of the property where the Forum takes place, other persons present at the Forum, transient dizziness, lightheaded, fainting, nausea, muscle cramping, musculoskeletal injury, joint pains, sprains and strains, heart attack, stroke, or sudden death.  I agree that if I experience any of these or any other symptoms during the Forum, I will discontinue my participation immediately and seek appropriate medical attention. I DO HEREBY RELEASE AND FOREVER DISCHARGE THE RELEASEES FROM ANY AND ALL CLAIMS WHATSOEVER WHICH ARISE OR MAY HEREAFTER ARISE ON ACCOUNT OF ANY INJURIES, DAMAGES, FIRST AID, TREATMENT, OR SERVICE RENDERED IN CONNECTION WITH MY PARTICIPATION IN THE FORUM.

I further covenant and agree to indemnify and hold harmless the Releasees from any loss, liability, damage or costs, including attorneys’ fees and court costs, that may arise out of or that are related to my participation in the Forum and travel related thereto, whether caused by the negligence of the Releasees or otherwise.

It is my express intent that this Participant Release and Waiver of Liability and Indemnification Agreement (“Release”) bind my family members, spouse, heirs, assigns, personal representatives, and anyone else entitled to act on my behalf, and is deemed as a release, waiver, discharge, and covenant not to sue the Releasees.

I further covenant and agree that this Release shall be construed in accordance with the laws of the State of Wisconsin and that any mediation, suit or other proceeding relating to this Release and any activities covered hereby must be filed or entered into only in Wisconsin and the federal or state courts of Wisconsin. Any portion of this Release deemed unlawful or unenforceable is severable and shall be stricken without any effect on the enforceability of the Release as a whole to the full extent authorized by law.

I have read and fully understand this Release as set forth above and understand that I have given up substantial rights by signing it. I certify that I have reached the age of majority, have signed under my own free will and am suffering under no legal disabilities.