Fiddler's Green Stables
COVID-19 ATTESTATION AND AGREEMENT
By signing below, the participant (named below) or the participant’s Guardian attests that the they: 1. Do not knowingly have COVID-19; 2. Are NOT experiencing any known symptoms of COVID-19, such as fever, cough, shortness of breath, sore throat, loss of taste or smell, headache, nausea, vomiting, diarrhea, abdominal pain or malaise. 3. Have not travelled internationally during the past 14 days; 4. You have not travelled outside of the Ottawa area nor had visitors travel to you from outside the Ottawa area in the last 14 days; 5. Have not frequented a COVID-19 high risk area in the Province/Territory during the last 14 days; 6. Have not, in the past 14 days, knowingly come into contact with someone who has COVID-19, who has known symptoms of COVID-19 or is self-quarantining after returning to Canada; and, 7. Have been following government recommended guidelines in respect of COVID-19, including practicing physical distancing. If you have answered YES to any of these questions, please RETURN HOME AND SELF-ISOLATE. Furthermore, by signing below, the participant agrees that while attending the Fiddler's Green Stables or attending an event at the facility, they: 1. Will follow the laws, recommended guidelines, and protocols issued by the Government of the Province in respect of COVID-19, including practicing physical distancing, and will do so to the best of their ability while attending Fiddler's Green Stables or attending an event at the facility; 2. Will follow the guidelines and protocols mandated by Fiddler's Green Stables in respect of COVID-19; 3. Will, in the event that that they experience any symptoms of illness such as a fever, cough, difficulty breathing, shortness of breath or malaise, WILL IMMEDIATELY: Inform the competition organizer; and, Depart from the facility immediately.
Participant Name
*
First Name
Middle Name
Last Name
Is Participant a minor?
*
Please Select
Yes
No
Guardian Name (if participant is a minor)
First Name
Last Name
Signature of participant (or guardian if participant is a minor)
*
Clear
Date
*
-
Month
-
Day
Year
Date
Submit Application
Clear Fields
Should be Empty: