COVID-19 Health Declaration

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

I am aware of the existence of the risk on my physical apparance to the venue and my participation of the activity of the Organization that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.

My child and I are not experiencing symptoms of fever, fatigue, difficulty in breathing, or dry cough nor exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 14 days. I have not been, nor any member(s) of my household, diagnosaed to be infected of COVID-19 virus within the last 30 days.

I am fully and personally responsible for my own saftey and the safety of my child and actions while and during my participation, and I recognize that I may be at risk of contracting COVID-19. With full knowledge of the risks involved, I hereby release, waive, discharge the Organization, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19. I agree to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims, arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19. By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free acrt and deed; that i give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.

Initials

Date

I declare that the info I’ve provided is accurate & complete

I accept terms & conditions

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