Player Name and Number: ______________________________________________
Player Email and Phone Number: _________________________________________
Today’s Date: ______________
Please read each question thoroughly and completely. This questionnaire must be filled out for attendance at every event.
- Do you currently have a fever or any symptoms associated with communicable illnesses (e.g. Covid-19, Flu, or RSV)? Symptoms include but are not limited to fever, new or worsening shortness of breath,new or worsening headache, new or worsening dry cough, new or worsening body aches, loss of taste/smell, new or worsening fatigue, sore throat, and new or worsening gastrointestinal distress? Allergy symptoms are noted and we recognize the nuanced line they present, however, if you are experiencing new, worsening, or excessive coughing, sneezing, or congestion that counts as a YES.
- YES / NO
- Have you had any of the aforementioned new or worsening symptoms listed in question one within the last week?
- YES / NO
- Has anyone in your household been diagnosed with Covid-19 or asked to self-quarantine within the last week or are awaiting the results of a Covid-19 test ?
- YES / NO
IMPORTANT- READ COMPLETELY- If the answer is yes to questions 1-3, you will be barred from admittance to the event unless you are able to provide proof of a negative Rapid/Home Covid diagnosis and you have been symptom free for at least 24 hours before game start. Said Covid test must be administered the day of game start. You will need to provide this information ahead of time to a member of the Safety Team with a date and timestamp for verification. If it is discovered a player has lied on this portion of the questionnaire, they will receive severe consequences. There are no exceptions.
- Do you have any conditions or injuries that may limit your ability to safely participate in strenuous physical activity and physical combat?
- YES / NO
- If your answer is yes, you are welcome to see a Safety Team Member to be signed off for Green Headband once you have your card.
- Are you feeling well enough mentally and emotionally to participate in the 24 hour LARP experience? We understand this is a fine and very personal line, but players must recognize that being in stressful and demanding situations has the potential to exacerbate adverse mental states.
- YES / NO
- If your answer is no, we kindly ask that you take as much time away from the game as you need in order to feel that you are able to join gameplay and have a good time.
Health and General Liability Waiver and Release
By signing this form below, I acknowledge that it is my responsibility to ensure my own safety and well- being by following Knight Realms health guidelines and standards throughout the event and that I understand what is asked of me . I do not hold Knight Realms LLC or any parties associated with them liable for any illnesses I may acquire while in attendance of officially sanctioned events. Furthermore I am aware of the physical risks involved with outdoor activities and do not hold Knight Realms LLC, Camp Sacajawea LLC or any parties associated with them liable for any injuries I sustain while on Camp Sacajawea or while attending or participating in a Knight Realms Event.
Signature _________________________________________ Date _____________
Present staff member __________________________________________________