Affirmation of Safety Guidelines and COVID-19 health screen: 2021-22 Winter League #4

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Affirmation of Safety Guidelines and COVID-19 health screen: 2021-22 Winter League #4 - University of Washington 12/18/21)

Please indicate your acceptance of the rules and evaluate your possibility of having COVID-19 by filling out this form. We're asking for your email address and name for identification purposes, so please use the email address you used to register, if possible.

Email *

We need a form filled out for every runner, shadow, coach, and volunteer that will be participating. This form is for (type First and Last name, preferably the same way as in your registration): *

Parent Name (if filling out for minor)

If running in a group or shadowing, what is the name of your partner?

COVID-19 Safety Guidelines

You have an important role to play in facilitating a safe event, and we ask that you follow #RecreateResponsibly guidelines and adhere to the guidelines below to help us keep you and our broader community safe:

Maintain Physical Distancing

- Avoid gathering around others, and keep at least a six-foot interpersonal distance from anyone not in your household whenever possible
- Arrive at the event site no earlier than you need to in order to comfortably check in and prepare to start, and at most one hour before your start time.

Wear a Mask & Practice Good Hygiene

- Wear a mask or face covering at the event. Masks with vents, one-ply bluffs, and bandanas are not allowed. Masks must cover your nose and chin. You may want to bring an extra mask in your pocket in case yours get wet while running.
- Wash your hands with soap for at least 20 seconds or use hand sanitizer frequently, plus immediately after contact with respiratory fluids or possibly contaminated objects, like portable toilet doors and other commonly-touched surfaces.
- If you need to cough or sneeze please cover it with a tissue (which you should then throw away as soon as possible) or with your elbow.
- Avoid touching your mouth, nose, and eyes.

Stay Home if You’re Sick or Vulnerable

- Do not attend the event if you have a temperature of 100.4F or greater, feel sick, or believe you may have recently been exposed to the COVID-19 virus
- Carefully consider whether you should attend the event if you are a member of a high-risk group or are in close contact with one or more people in a high-risk group (per CDC: 65+, immune compromised, having another health condition that exacerbates COVID-19)
- If you begin to experience the flu-like symptoms of COVID-19 while you are at the event, please immediately notify a staff person (at a safe distance) and self-quarantine away from others until you are able to safely depart the event.

Have you read the above COVID-19 safety guidelines (also on the event website)? *

Yes

Do you agree to follow the above COVID-19 safety guidelines? *

Yes

In the past two weeks, have you had or tested positive for COVID-19 or have you been in close contact with a person who was infected with COVID-19? *

Yes

In the past two weeks, have you or anyone you live with been instructed to self-quarantine? *

Yes

In the past two weeks, which of these symptoms have you had? *

Fever or chills

Cough

Shortness of breath or difficulty breathing

Fatigue

Headache

New loss of taste or smell

Sore throat

Congestion or runny nose

Nausea or vomiting

(none of the above)

Required

We will attempt to contact you after the event if we discover that you may have been exposed to someone who was infected with COVID-19. *

I understand

Required

We ask that you contact us if you find that you have COVID-19 within two weeks after attending our event. *

I understand

Required

Send me a copy of my responses.

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