CE23 Covid Guidelines and Assessment

Athlete Name*

First NameLast Name
Athlete Email*
example@example.com
Do you have any of the following:*

FeverCoughSore ThroatPainful SwallowingHeadacheRunny NoseUnexplained loss of appetiteDiarrheaLoss of sense of smell or tasteRed or purple spots on hands or feetNONE OF THE ABOVE
Have you been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days? **

YesNo
If you answered YES to any of these questions, please remain at home, self isolate immediately, and call 811.
Liability Waiver - check each box below to acknowledge that you have read and understand each statement **

I acknowledge the contagious nature of COVID-19 and agree to adhere to social distancing guidelines recommended by public health officialsI acknowledge COVID-19 exposure/infection may result from the actions of myself and others and their familiesI agree to follow all safety precautions outlined by CE23 Basketball and NLSC (Powerplex)I acknowledge CE23 can not guarantee that I will not become infected with COVID-19
Date*

MonthDayYear
Date
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*
Should be Empty: