COVID-19 Advise, Consent, and Waiver for participation in Athletics for The Episcopal School of Dallas

Student-Athlete Name:                                  


Parent Name:

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

I agree to comply with all rules imposed by ESD regarding the use of the facility and participation in Athletics. I agree that if my child(ren) is learning remotely or is not in attendance, they will not be allowed to participate in Athletics (practice or game). My child will conduct himself or herself in a controlled and reasonable manner at all times, and will refrain from using any equipment in a manner inconsistent with its intended design and purpose. I understand and acknowledge that the use of exercise equipment involves risk of serious injury, including permanent disability and death. I understand the policies and procedures ESD has set in place to ensure the health and safety of my child(ren).

I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren), my family and I may be exposed to or infected by COVID-19 by using the Facility and participating in Athletics. I understand that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the facility and participating in Athletics may result from the actions, omissions, or negligence of myself and others, including, but not limited to, ESD employees, volunteers, and program participants and their families. I voluntarily agree to abide by ESDs policies and procedures in the case of a COVID-19 exposure, or positive case at a practice, away/home game, or from the opposing team. I voluntarily agree and will follow ESDs policies and procedures in the case there is a positive case or exposure to a positive case that my child(ren) will be placed in quarantine for 14 days.

In consideration of my child’s use of the facility and participation in Athletics, I voluntarily agree to

assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the facility or participation in Athletics programs (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Facility, ESD, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Facility and ESD, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in the Facility.

I hereby certify that I will screen and have screened my child and that he or she has not exhibited any of the following prior to their entry into the Facility each day:

Symptoms of acute respiratory illness (runny nose, congestion, cough)

Fever > 100.0˚F



Repeated shaking with chills

Muscle pain


Sore Throat


Abdominal pain 

Shortness of breath (not severe/severe)

Recent loss of taste or smell

Sick members in the household currently

Contact in the last 2 weeks with someone that has been ill or tested positive for COVID-19

**If you have answered yes to the above for your child, they should NOT come to

campus until after a 14-day self-quarantine.**

Parent Signature:                                                                     Date:


Athlete Signature:                                                                    Date:

Coach Signature:                                                                     Date: