TIER 1 ENS Covid -19 Acknowledgment & Liability Release Waiver

The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the Ontario Hockey Federation has set recommendations, guidelines, and some prohibitions which Erie North Shore Minor Hockey adheres to comply. All questions must be completed prior to participation in on or off ice activities.

In consideration of the participation in the Activity, the undersigned acknowledges the following all question must be checked and all symptoms must be "NO": *

COVID-19 is a global pandemic and that infections have been confirmed throughout the Province of Ontario, including Windsor-Essex County where the Activity is being administered. The Organization cannot guarantee my safety or that I won’t be exposed to COVID-19 as a result of my participation in the Activity. I have not, nor have any member(s) of my household or social bubble, been diagnosed to be infected with COVID-19 within the last 14 days. I have not, nor any member(s) of my household, traveled outside Canada in the last 14 days. (This does not included essential workers who cross CAN/US border regularly) I have not experienced symptoms associated with COVID-19 including but not limited to fever, fatigue, difficulty in breathing, or dry cough feeling confused, losing consciousness, or any other symptoms relating to any communicable disease within the last 14 days. I have not been, nor any member(s) of my household or social bubble to the best of my knowledge, been in close contact with someone who has tested positive or exhibited symptoms of the COVID-19 virus or any other communicable disease within the last 14 days. I am aware of the existence of the risk to my health by my participation in the Activity, including the risk of contracting COVID-19 which may result in injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to, among other things, paralysis or death and that I may spread the COVID-19 virus to others who may suffer similarly. That other participants in the Activity may knowingly or unknowingly have answered the foregoing questions falsely and / or have been exposed to or contracted COVID-19 themselves, thereby putting other participants at risk of contracting COVID-19. That notwithstanding the care and effort of the Organization, I may be exposed to COVID-19 as a result of participation in the Activity. I, the undersigned parent or legal guardian of the child(ren) shown below, have read and understand the above COVID-19 Liability Release Waiver and agree to its terms on behalf of my child(ren) and myself. I acknowledge that by signing and completing this Waiver I am assuming the risks of the activity at the Facility on behalf of my child(ren) and myself. I do not have a fever or Chills ( feeling hot to the touch temp of 37.8C or higher I do not have a cough that's new or worsening ( continuous, more than usual) barking cough, making a whistling noise when breathing (croup) shortness of breath ( our of breath, unable to breathe deeply) I do not have a Sore throat, Difficulty swallowing I do not have running nose, sneezing or nasal congestion( not related to seasonal allergies or other known causes or conditions) I do not have lost sense of taste or smell, Digestive issues (nausea/vomiting, diarrhea, stomach pain) I do not have Pink eye (conjunctivitis) Headache that's unusual or long lasting I do not have muscle aches, or extreme tiredness that is unusual (fatigue, lack of energy) I haven't fallen down often, nor sluggishness or lack of appetite

Following the acknowledgements above, I hereby agree to the following *

I am fully and personally responsible for my own safety and actions while and during my participation in the Activity and I recognize that I may be at risk of contracting COVID-19 by my participation in the Activity. With full knowledge of the risks involved, I hereby release, waive, and discharge the Organization, its employees, owners, 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 or anyone claiming through me related to COVID-19 as a result of my participation in the Activity while in, on, or around the premises or while using the facilities used in connection with the Activity 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 the Organization due to injury, loss, or death from or related to COVID-19 associated with my participation in the Activity.

By signing below I acknowledge that I have read the 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 act and deed with full intention to be bound by the same, and free from any inducement or representation other than my ability to participate in the Activity.

For Minority Age Children (Under 18 Years of Age)

This is to certify that I, as parent/guardian/adult with responsibility for the below child(ren), have read and explained the provisions in this Waiver to the child(ren) including the risks of the Activity and his/her responsibilities for adhering to the rules and regulations put in place by the Organization in connection with their participation in the Activity.

Complete one assessment each per Player , Parent/Guardian and Program Leader *

Player Parent / Guardian Program Leader

Player / Program Leader/ Parent name *

First Name Last Name

Phone Number *

Email *

example@example.com

Select Arena *

Kingsville Harrow

Ice Time *

Signature *

Clear

TIER 1 COVID-19 Acknowledgment & Liability Release Waiver complete day of