COVID-19 Participant Code of Conduct & Risk Assessment Form & Waiver and Release of Liability

Please read before completing form

Who is at higher risk of COVID-19?

COVID-19 is a new disease and information is changing on who is more likely to get COVID and who is will have more complications. Based on currently available information and clinical expertise, people with intellectual and developmental disabilities may be at higher risk of severe illness resulting in death from COVID-19

Current clinical guidance and information from the U.S. CDC lists those at highrisk for severe illness from COVID19 as:

• People 65 years and older
• People who live in a nursing home or longterm care facility (like a congregate or group home)

Regardless of age, individuals with underlying conditions, such as the following, are or maybe at increased risk of severe illness from COVID-19:

• People with chronic lung disease, chronic obstructive pulmonary disease or moderate to severe asthma
• People who have serious heart conditions (including heart failure, coronary artery disease, congenital heart disease, cardiomyopathy, hypertension)
• People who are immunocompromised
  • Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
• People with obesity (body mass index [BMI] of 30 or higher). To calculate BMI, refer to:
  • https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html
• People with diabetes (Type 1 and 2)
• People with chronic kidney disease
• People with liver disease
• People with dementia

 The list may change as evidence is learned.  Please review the latest list of conditions that put individuals at increased risk available at the CDC website (https://bit.ly/2VEJcSK)

If you are at a high risk, you may be putting yourself at risk when you return to activities with Special Olympics. But, you may also put at risk your family and your teammates. If you have these conditions, you should not return to Special Olympics in person activities until there is little to no COVID-19 in your community.

If you have been diagnosed with COVID-19, you should consult with a healthcare professional for written medical clearance before returning to Special Olympics in person activities as serious cardiac, respiratory, and neurological issues may develop as a result of COVID-19.

I understand I could get Coronavirus through sports, training, competition and/or any group activity at Special Olympics. I am choosing to participate in sports, competition and/or other Special Olympics activities at my own risk.

During the time these precautions are needed, I agree to the following to help keep me and my fellow participants safe:

WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT FOR COMMUNICABLE DISEASES

(“Agreement”) for

SPECIAL OLYMPICS 

In consideration of being allowed to participate in any way in Special Olympics sports training, competition or fundraising activities, the undersigned acknowledges, appreciates, and agrees that:

 

1. Participation includes possible exposure to and illness from infectious and/or communicable diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,

 

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

 

3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

 

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Special Olympics, Inc., Special Olympics Oklahoma, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ ALL OF THIS AGREEMENT OR HAVE HAD IT READ TO ME AND AGREE TO FOLLOW THESE ACTIONS.

PARTICIPANT SIGNATURE (required for adult (age 18+) participants, including adult

athlete with capacity to sign documents)

By signing this, I acknowledge that I have completely read and fully understand the information in this form.

 

If you have touch screen use your finger if you have mouse click and hold signing your name.

Put X below if Parent/Guardian Signature

PARENT/GUARDIAN SIGNATURE (required for participant who is a minor (younger

than age 18) or lacks capacity to sign documents)

I am a parent or guardian of the athlete/participant named above. I have read and understand this form and have explained the contents to the participant as appropriate. By signing, I agree to this form on my own behalf and on behalf of the participant.

If you have touch screen use your finger if you have mouse click and hold signing your name.

Put X below if Participant Signature

Click on the Save/Download/Print Form button (DO NOT CLICK LOGO) and follow the Covid Code of Conduct procedures in how to submit this form into SOOK. Thank you!