LIABILITY RELEASE and CONSENT
Medical Release and Authorization, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment to my life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact my next of kin in the most expeditious way possible. This authorization is granted only after I myself cannot give authorization. Permission is also granted to the Rodney Hoops LLC . and its affiliates including Directors, Coaches, and Staff to provide the needed emergency treatment prior to the admission to the medical facility.Release authorized on the dates and/or duration of the registered season.This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of myself
Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), our business is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance.Symptoms of COVID-19 include:
• Fever• Fatigue
• Dry Cough• Difficulty BreathingI agree to the following:
• I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.
• I affirm that I, as well as all household members, have not been diagnosed withCOVID-19 within the past 30 days.
• I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days.
• I affirm that I, as well as all household members, have not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days.
• I understand that RODNEY HOOPS LLC/HarborImpact LLC cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.Our business is following theses enhanced procedures to prevent the spread of COVID-19:• [list how your business is enhancing protection for clients amid COVID-19]By signing below, I agree to each statement above and release RODNEY HOOPS LLC from any and all liability for unintentional exposure or harm due to COVID-19.