COVID-19 Waiver and Consent Form
Please fill in the form below.
Participant Information
Athlete's Name
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Prefix
First Name
Last Name
Date of Birth
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Month
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Day
Year
Date Picker Icon
Parent/Guardian Name
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Prefix
First Name
Last Name
Relationship to Participant
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Emergency Contact Number
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Area Code
Phone Number
Electronic Waiver, Consent and Release of Liability
I am the parent/guardian of the child register herein. I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the province of Ontario and many other public health authorities still recommend practising social distancing. I further acknowledge that The Lab Basketball has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that The Lab Basketball cannot guarantee that the child that I have registered above or myself will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of the child that I have registered above, myself and others. I voluntarily seek services provided by The Lab Basketball and acknowledge that the child that I have registered above and myself are increasing our risk to exposure to the Coronavirus/COVID-19. I acknowledge that the child that I have registered above and myself must comply with all set procedures to reduce the spread while attending our appointment and the child that I have registered above's training session. I attest that: * The child that I have registered above and myself are not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. * The child that I have registered above and myself have not travelled internationally within the last 14 days. * The child that I have registered above and myself have not travelled to a highly impacted area within the United States of America in the last 14 days. * The child that I have registered above and myself do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. * The child that I have registered above and myself have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by the province of Ontario or local public health authorities. * The child that I have registered above and myself are following all provincial and local public health authorities and their recommended guidelines as much as possible and limiting our exposure to the Coronavirus/COVID-19. * The child that I have registered above and myself are entering The Lab Basketball training facility premises voluntarily and of our own free will without any coercion by any person or company and being fully aware that we are in the midst of a COVID-19 virus pandemic and the virus appears to be highly contagious. * The child that I have registered above and myself will maintain at least a 6 foot or 2 metres of social distance from all other persons while in or on The Lab Basketball training facility premises. * The child that I have registered above and myself will not touch any surfaces in The Lab Basketball training facility premises and if we need to touch or open anything, we will request The Lab Basketball’s coach/training instructor(s) to do so for us. * The child that I have registered above and myself will ensure to wash our hands upon entry and exit from The Lab Basketball training facility premises while understanding and agreeing that this may still be limited in the effectiveness of preventing viruses or diseases of any kind like the Coronavirus/COVID-19. I hereby release and agree to hold The Lab Basketball harmless from, and waive on behalf of the child that I have registered above and myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to the child that I have registered above and myself and/or property that maybe caused by any act, or failure to act of the The Lab Basketball training facility, or that may otherwise arise in any way in connection with any services received from The Lab Basketball. I understand that this release discharges The Lab Basketball from any liability or claim that the child that I have registered above and myself, my heirs, or any personal representatives may have against The Lab Basketball training facility with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to any services received from The Lab Basketball. This liability waiver and release extends to The Lab Basketball training facility together with all owners, partners, and employees.
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I have read and agree to the terms of the event waiver and disclaimer stated above
Parent/Guardian Signature
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