Form test Winterfest 2020 Name First Last Email* Company Name* Credit Card Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Drive-In Concept PRICE IS PER CAR Quantity* Price: $20.00 Quantity Total $0.00 The coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and increased personal protection efforts, including frequent hand washing and wearing face coverings at all times outside the home. The Wellington Chamber of Commerce has put in place precautionary measures aimed at preventing and reducing the spread of COVID-19 among attendees of our December 5th , Winterfest Event. However, the Wellington Chamber of Commerce cannot guarantee that you (or those you come in close contact with) will not become infected with COVID-19. Further, attending the Chamber’s event (including your travel to and from such event) could increase your risk of contracting COVID-19. By registering for, signing below and attending the event: You acknowledge the contagious nature of COVID-19 and voluntarily assume all risk that you may be exposed to or infected by COVID-19, and/or Multisystem Inflammatory Syndrome (MIS-C) and that such exposure or infection may result in personal injury, illness, permanent disability, and death to you or those with whom you come into close contact. You further acknowledge and agree to accept sole responsibility for any injury (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, to you or those with whom you come into close contact (including your household members)(“Claims”). You hereby release, covenant not to sue, discharge, and hold harmless the Wellington Chamber of Commerce , its employees, board of directors, and representatives, of and from any Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. You further understand and agree that this release includes any Claims based on actions, omissions, or negligence of the Wellington Chamber, its employees, board of directors, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Chamber event. You agree to abide by posted rules, warning or instructions by the Wellington Chamber, the venue where the event is held and any government authority with respect to social distances, adherence to any dress code (including mandatory face coverings) and sanitation guidelines. Posted rules include but are not limited to: remaining in your car/and or designated space outside of your car, utilizing on site bathroom facilities ( designated in your row), keeping 6 feet apart in food lines and not gathering in large groups outside of your 10x10 space. Face coverings are mandatory when you are not able to socially distance. You further agree not to attend the event if you are diagnosed with or suspect that you may have been infected by COVID-19, and in the event you become ill or suspect you have been infected with COVID-19, you agree to immediately discontinue your participation in the event and alert the Wellington Chamber via e-mail or telephone. If you cannot agree to or accept the foregoing, DO NOT ATTEND WINTERFEST. Failure to agree to or abide by any of the foregoing may result in denial of entry or immediate expulsion from the event, in the Wellington Chamber’s sole discretion, in addition any and all remedies which may be available to the Wellington Chamber, in equity or at law. By signing this you are assuming all responsibility for yourself and all persons in your car at Winterfest 2020.* Registered Attendee’s First and Last Name Registered Attendee’s First and Last Name (SIGNATURE) Date Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name