Recreation Standard Waiver

The following form is required to be completed by all families who will participate in a North Caldwell Recreation program.

Recreation Program

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Any symptoms in the last 72 hours: fevers or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headaches, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting?

"WARNING: Please check your answers. You have provided an answer which indicates your presence poses a risk to the public health and you should not be participating in public recreational activities. As such, you will not be permitted access to screened locations. Thank you for your cooperation."

Have you or any participating family members had exposure to individuals with suspected or confirmed COVID-19 within the previous 14 days?

"WARNING: Please check your answers. You have provided an answer which indicates your presence poses a risk to the public health and you should not be participating in public recreational activities. As such, you will not be permitted access to screened locations. Thank you for your cooperation."

Quarantine required based on CDC and Department of Health travel guidelines.

"WARNING: Please check your answers. You have provided an answer which indicates your presence poses a risk to the public health and you should not be participating in public recreational activities. As such, you will not be permitted access to screened locations. Thank you for your cooperation."

By submitting below I agree that my family, guests and I will follow all posted Rules and Guidlines from Borough and pool staff. Such rules are drawn from the CDC Public Pool Guidance, CDC Social Distancing Guidance and Borough of North Caldwell Facility Aquatics Plan. Additionally, I have read and understand the Recreation Department Standard Waiver.

Date

DateHourMinutesAM/PM Option

North Caldwell COVID-19 Pre-Admission