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 I, ____________________________, am agreeing to participate in the Galena Roasters Cupping Event, to be held on or about (insert Month/Day/Year) _____________________.  In consideration of the acceptance of my application to participate, I do hereby: 

  1. Agree to waive and release all claims against Galena Roasters LLC, d/ b/a GALENA ROASTERS for any injury, damages, or expenses of any kind, whether for claims of negligence, tort, contract, or otherwise, including but not limited to agony’s fees, claims related to any injury, loss, damage, accident, delay, or other expense arising from any activity relating to the Trip, including any such damages relating to the use of any vehicle, war, terrorist act, weather, sickness (including but not limited to COVID-19), quarantine, government restrictions or regulations, or arising from any act or omission of any transportation carrier, hotel, restaurant or any other firm, agency, company or individual; EXCEPT that nothing in this paragraph shall limit GALENA ROASTERS’ liability for damages which are a direct result of gross negligence or willful misconduct of GALENA ROASTERS. 

  2. Affirm that I do not have, and have not had within the previous two weeks, any of the following: 

       a.     A fever, a feeling of feverishness, or chills 

       b.     A cough or sore throat 

       c.      Shortness of breath or difficulty breathing, muscle pain 

       d.     Loss of taste or smell 

       e.     GI upset or diarrhea 

       f.      Any other flu-like symptoms 

       g.     Contact with any other person who has tested positive for COVID-19 or who has exhibited any of the above symptoms 

       h.     A positive COVID-19 test 

       i.      Travel to or from any municipality or region identified at the following link, or any of the locations addressed in the                            executive orders or other travel advisory documents linked therein:

       j.      I affirm that in the event that I do experience any of the above symptoms within two weeks of my travel date, or if I have                  any travel within any of the locations identified at the link above, I will immediately notify GALENA ROASTERS. I                              understand that GALENA ROASTERS may cancel or postpone my participation  in the cupping event if I experience                        COVID-19 symptoms or visit any of the above locations within two weeks of my travel date. 

 3.   Agree to follow the CDC’s current guidelines and recommendations for reduction of COVID-19 spread contained at the                   following link:  


      I understand that regardless of these precautions, there is always a risk of exposure to the novel coronavirus, the             highly contagious pathogen which causes COVID-19, in traveling, being in close contact with other individuals,                 and/or visiting any public location. I understand that COVID-19 may cause severe illness, up to and including death,         and that this risk exists for all individuals but is increased for individuals with certain preexisting medical conditions,       including but not limited to individuals with diseases and disorders of the lung, people who are                                             immunocompromised, people with HIV, people with liver disease, people with a BMI of 40 or higher, people who are           65 years old and older, people with certain heart conditions, people with diabetes, and people with chronic kidney            disease. By attending this event, I voluntarily assume all risk associated with exposure to the novel coronavirus                and/or contraction of COVID-19. 

 4.  Agree to indemnify, defend and hold harmless GALENA ROASTERS with regard to any financial obligations or liabilities that I         may personally incur, and/or for any damage or injury to others I may cause while participating in this Trip. 

 5.  Acknowledge that GALENA ROASTERS and its agents will not provide on my behalf any all-risk insurance, such as casualty,         accident, and liability insurance, to cover liability for death, personal injury, illness, property loss or property damage resulting         from my participation in this program. 

 6.  Acknowledge that, as a registered guest of GALENA ROASTERS, I am expected to comply with the rules and conduct myself         in a reasonable manner while so registered.  GALENA ROASTERS reserves the right to revoke the registration of any guest           who fails to comply with the above.  This revocation may include the cancellation of payment for further accommodations and         travel. 

 7.  By participating in the event, I grant to GALENA ROASTERS the unconditional, perpetual, irrevocable right to use my name,           persona, and likeness in connection with any media generated during the event (including but not limited to photographs and         video), without any obligation or remuneration to me. I understand that I will not receive any fees, sums, consideration, or               remuneration for any of the rights I have granted herein, and I agree that I shall have no right of approval, claim to                           compensation (including, but not limited to, license fees and/or royalties), and no claim (including, but not limited to, claims for       invasion of privacy, defamation, right of publicity, copyright infringement, or trademark infringement) arising out of any use of           my name, persona, or likeness by GALENA ROASTERS or its subsidiaries, partners, and affiliated companies. 

 8.  In the event that I need medical treatment during participation in this Trip, or any events incidental to this Trip, I agree to be             financially responsible for any costs incurred as a result of such treatment. 

 9.  In the event that I am accompanied to the cupping by a minor child or minor children, I certify that I am the child’s parent or             legal guardian, that I have the authority to make legal decisions on behalf of the minor child or minor children, and I do hereby       accept and agree to all paragraphs in this document on behalf of the minor child(ren) in addition to on my own behalf. I agree         to notify GALENA ROASTERS if the minor child(ren) experiences any symptom or travel to any location described in                       Paragraph 2 above within two weeks of our travel date, and I understand that the Trip may be cancelled or postponed by               GALENA ROASTERS following such notice. 

 10. I have read this document and I understand it. I understand the legal consequences of this document, including: (1)                        indemnifying and releasing GALENA ROASTERS from all liability on behalf of myself and/or any minor children ax ending the        Trip with me; (2) waiving my right and the rights of any minor children ax ending with me to sue GALENA ROASTERS, except        in instances of GALENA ROASTERS’ gross negligence or willful misconduct; and (3) granting to GALENA ROASTERS the            right to use my name, persona, and likeness, and that of any minor children ax ending with me, in connection with any media          generated during the Trip. 

Dated this _______ day of _______, 20___. 

___________________________                   ___________________________
Print Name                                                      Signature

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