"Parent/Legal Guardian Covid-19 General Waiver and Release of Liability for in-Person Visiting" - Michigan

Parent/Legal Guardian Covid-19 General Waiver and Release of Liability for in-Person Visiting is a legal document that was released by the Michigan Department of Corrections - a government authority operating within Michigan.

Form Details:

  • Released on March 19, 2021;
  • The latest edition currently provided by the Michigan Department of Corrections;
  • Ready to use and print;
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  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Michigan Department of Corrections.

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Michigan Department of Corrections
Parent/Legal Guardian COVID-19 General Waiver and Release of Liability for In-Person Visiting
Due to the ongoing novel Coronavirus (COVID-19) pandemic, the Michigan Department of Corrections is taking extra precautions
when resuming in-person visiting.
Symptoms of COVID-19 may include:
Fever of 100.4+ degrees
Sudden fatigue
Nausea or vomiting
Chills, sweats, or shaking
Muscle or body aches
Abdominal pain
New or worsening cough
New onset of headache
Diarrhea
New or worsening shortness
New loss of taste or smell
of breath
New sore throat
By initialing each box, the parent/legal guardian agrees to the following:
I understand the above symptoms and affirm that the minor child—and members of their household—does not have and
has not experienced the symptoms listed above within the last 14 days.
I acknowledge that the minor child’s temperature reading today was less than 100.4 degrees and the minor child’s antigen
test was negative (ages 2 and up only).
I affirm that the minor child—and members of their household—has not been diagnosed with COVID-19 in the past 20
days.
The minor child has not knowingly been exposed to anyone diagnosed with or suspected of having COVID-19 within the
past 14 days.
I understand that the Centers for Disease Control (CDC) has stated that there is evidence that persons with COVID-19 may
be asymptomatic or pre-symptomatic, and that the virus may be transmitted to others by the minor child if they are such a
carrier.
I understand that the minor child is being allowed to visit during a pandemic, and that the minor child must follow all
visitation rules and requirements, including but not limited to:
Wearing an appropriate mask over their nose and mouth for the duration of their visit (ages 2 and up only).
o
Being mindful of social distancing, keeping 6 feet away while in common areas. No physical contact except one
o
embrace at the beginning and end of the visit.
Practicing good handwashing hygiene and utilizing available hand sanitizer.
o
I understand that despite adhering to all precautions, there is still a possibility that the minor child will be exposed to or
contract COVID-19.
Persons with underlying health conditions may be particularly susceptible to illness and death from COVID-19. Such conditions
include, but are not limited to: heart disease, lung disease, suppressed immunity system, obesity, diabetes, kidney disease, liver
disease, etc. Some children can get severely ill from COVID-19, including hospitalization, intensive care, or in rare cases, death.
The CDC and partners are investigating a rare but serious, potentially deadly, medical condition associated with COVID-19
called Multisystem Inflammatory Syndrome in Children (MIS-C). Many children with MIS-C had the virus that causes COVID-
19 or had been around someone with COVID-19. I have been advised and willingly choose to allow the minor child to visit,
understanding the minor child’s own health condition(s).
I have read the above and understand it is not inclusive of all risks and safety measures related to COVID-19. I am allowing the
minor child to visit a prisoner incarcerated with the Michigan Department of Corrections during the pandemic. In accordance
with applicable law and facility policy, I agree to enter into this general wavier and release of liability. By signing this
agreement, I waive and release the State of Michigan, its agencies, employees, agents, predecessors, successors and indemnors,
heirs and assigns, from any and all liability, including claims, demands, obligations, actions, causes of action, damages, costs, and
fees, whether based on a tort, contract, or any other theory of recovery, legal or equitable, arising out of the minor child
contracting COVID-19.
I have read and voluntarily sign this agreement effective as of the date set forth below.
1.
Name of Minor Child:
2.
Name of Parent/Legal Guardian:
3.
Facility:
Signature of Parent/Legal Guardian
Date
Updated 3/19/2021
Michigan Department of Corrections
Parent/Legal Guardian COVID-19 General Waiver and Release of Liability for In-Person Visiting
Due to the ongoing novel Coronavirus (COVID-19) pandemic, the Michigan Department of Corrections is taking extra precautions
when resuming in-person visiting.
Symptoms of COVID-19 may include:
Fever of 100.4+ degrees
Sudden fatigue
Nausea or vomiting
Chills, sweats, or shaking
Muscle or body aches
Abdominal pain
New or worsening cough
New onset of headache
Diarrhea
New or worsening shortness
New loss of taste or smell
of breath
New sore throat
By initialing each box, the parent/legal guardian agrees to the following:
I understand the above symptoms and affirm that the minor child—and members of their household—does not have and
has not experienced the symptoms listed above within the last 14 days.
I acknowledge that the minor child’s temperature reading today was less than 100.4 degrees and the minor child’s antigen
test was negative (ages 2 and up only).
I affirm that the minor child—and members of their household—has not been diagnosed with COVID-19 in the past 20
days.
The minor child has not knowingly been exposed to anyone diagnosed with or suspected of having COVID-19 within the
past 14 days.
I understand that the Centers for Disease Control (CDC) has stated that there is evidence that persons with COVID-19 may
be asymptomatic or pre-symptomatic, and that the virus may be transmitted to others by the minor child if they are such a
carrier.
I understand that the minor child is being allowed to visit during a pandemic, and that the minor child must follow all
visitation rules and requirements, including but not limited to:
Wearing an appropriate mask over their nose and mouth for the duration of their visit (ages 2 and up only).
o
Being mindful of social distancing, keeping 6 feet away while in common areas. No physical contact except one
o
embrace at the beginning and end of the visit.
Practicing good handwashing hygiene and utilizing available hand sanitizer.
o
I understand that despite adhering to all precautions, there is still a possibility that the minor child will be exposed to or
contract COVID-19.
Persons with underlying health conditions may be particularly susceptible to illness and death from COVID-19. Such conditions
include, but are not limited to: heart disease, lung disease, suppressed immunity system, obesity, diabetes, kidney disease, liver
disease, etc. Some children can get severely ill from COVID-19, including hospitalization, intensive care, or in rare cases, death.
The CDC and partners are investigating a rare but serious, potentially deadly, medical condition associated with COVID-19
called Multisystem Inflammatory Syndrome in Children (MIS-C). Many children with MIS-C had the virus that causes COVID-
19 or had been around someone with COVID-19. I have been advised and willingly choose to allow the minor child to visit,
understanding the minor child’s own health condition(s).
I have read the above and understand it is not inclusive of all risks and safety measures related to COVID-19. I am allowing the
minor child to visit a prisoner incarcerated with the Michigan Department of Corrections during the pandemic. In accordance
with applicable law and facility policy, I agree to enter into this general wavier and release of liability. By signing this
agreement, I waive and release the State of Michigan, its agencies, employees, agents, predecessors, successors and indemnors,
heirs and assigns, from any and all liability, including claims, demands, obligations, actions, causes of action, damages, costs, and
fees, whether based on a tort, contract, or any other theory of recovery, legal or equitable, arising out of the minor child
contracting COVID-19.
I have read and voluntarily sign this agreement effective as of the date set forth below.
1.
Name of Minor Child:
2.
Name of Parent/Legal Guardian:
3.
Facility:
Signature of Parent/Legal Guardian
Date
Updated 3/19/2021