COVID-19 Health Acknowledgement & Liability Waiver

My presence at the 2021 3i SHOW held in Dodge City, KS, proves I voluntarily accept the risk of the potentially coming into contact with COVID-19 and by attending the event, I accept sole responsibility for any injury to myself and on behalf of my family, spouse, estate, heirs, executors, administrators, assigns, and personal representatives, including, but not limited to, illness, damage, loss, claim liability, or expense of any kind, that may be experienced or incurred in connection with my attendance at the event.

I understand that the risk of being exposed to or infected by COVID-19 at the 2021 3i SHOW may result from the actions, omissions, or negligence of myself, and others, including, but not limited to, Western Kansas Manufacturers Association, and/or its employees, officers, directors, representatives, agents, show staff, volunteers, event participants/attendees, and their families. I hereby release, covenant not to sue, discharge, and hold harmless Western Kansas Manufacturers Association, and/or its directors, officers, employees, representatives, and agents from any claim associated with allegedly being exposed to or infected by COVID-19 as a result of participating in Event activities and/or being on Event show grounds.

HEALTH PROTOCOLS:
• I have read, understand, and agree to comply with the Health Protocols and understand and agree that I may be disqualified from participating in the 3i SHOW and required to leave the show grounds should I fail to do so.
• I will, to the best of my ability, practice proper social-distancing as recommended by health department directives, as well as practice good hygiene (handwashing, use of hand sanitizer, wearing of a mask if and when required, etc.) and follow other health directives ordered or suggested.

HEALTH REPORTING:
• I have not experienced new or worsening symptoms of possible COVID-19 in the last 14 days, including cough, shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, loss of taste or smell, diarrhea, feeling feverish or a temperature greater than 100°F.
• I have not had close contact with a person symptomatic or confirmed to have COVID-19 in the last 14 days.
• I have not been diagnosed with COVID-19 within the last 14 days. If I have been infected by COVID-19 at any time, I have been medically released to return to normal activities.
• If I develop a fever and symptoms, such as a cough or difficulty breathing while at the event, or if I am diagnosed with COVID-19 while at the event, I will self-quarantine and immediately report this information to 3i SHOW’s show management.

Please familiarize yourself with the Health Protocols in place for the 2021 3i SHOW.

Please submit the completed form below. 

 

Please provide the name(s) of who will be working the booth.
Please provide the name of who should be contacted in the case of an emergency
Please provide the number for the emergency contact.
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