20-21 Waiver for Clubs, Activities, Events, Gym Use and Permits
COVID-19 Waiver, Release, and Agreement for Participation in Athletics and Other Extracurricular Activities
The student named below has requested permission to participate in extracurricular activities sponsored by Minnetonka Public Schools (the “School District”). For the purposes of this Agreement, extracurricular activities are voluntary, optional, noncredit activities, and include but are not limited to practices, training sessions, meetings, games, tournaments, projects, any other competitive endeavor, any related School District transportation to and from the foregoing, and entering and remaining in the premises where the extracurricular activity is being held (collectively, the “Activity”).
The School District is committed to taking significant health and safety measures and modifications to protect students and staff participating in the Activity. These measures will be based on applicable state and federal guidance and regulations, including but not limited to guidance from the Centers for Disease Control (“CDC”), the Minnesota Department of Health (“MDH”), and the Minnesota Department of Education (“MDE”).
However, even with caution and preventative measures, an inherent risk of exposure to COVID-19 exists in any public setting where people are present. COVID-19 is an extremely contagious disease that can be transmitted even by people who are asymptomatic and can lead to serious illness, permanent physical damage, and death. By participating in the activity, you and your child voluntarily assume all risks related to exposure to COVID-19 and/or any mutation or variant thereof.
**By signing below, I voluntarily acknowledge, affirm, and agree to the following:
1. I understand the inherent risks associated with exposure to COVID-19 and am voluntarily assuming such risks in order for me and/or my child to participate in the Activity. On behalf of myself, my child(ren), our estates, our heirs, our administrators, our executors, our assignees, and our successors, I hereby hold harmless, release, waive, covenant not to sue, and forever discharge Minnetonka Public Schools and its individual board members, agents, employees, and representatives, from and against any claims or liabilities, including claims based on negligence, for any losses, damages, illnesses, or injuries arising out of or relating to exposure to COVID-19 or its variants in connection with my or my child’s participation in the Activity. This waiver does not apply to claims based on intentional, willful, or wanton acts of the School District or its officials.
2. I affirm that neither I, my child, nor any person residing in my household, have been diagnosed with, demonstrated any symptoms of, or have in any way knowingly been exposed to COVID-19, within the past fourteen (14) calendar days. I further affirm that I have not been notified within the past fourteen (14) calendar days that I, nor any person residing in my household, has been exposed to COVID-19.
3. I agree that if I, my child, or any person residing in my household begin to experience symptoms similar to COVID-19, or if I, or any person residing in my household, are notified that I/they have been exposed to or infected with COVID-19 that I and my child will immediately cease participating in the Activity. Furthermore, if I, or any person residing in my household, are notified that I/they have been diagnosed with COVID-19 and I have participated in the Activity within the last fourteen (14) calendar days from the date of diagnosis, that I will immediately notify the School District of the diagnosis
We/I agree to all of the above information. (If you cannot answer 'Yes' you are unable to use district facilities or participate in programming using district facilities)
WE/I understand the signs and symptoms of Covid-19 and will NOT attend ISD 276 facilities if any of them are present in the participant. This includes daily temperature monitoring as the participants responsibility. Symptoms can be found:
(If you cannot answer 'Yes' you are unable to come on campus)
Parents First Name
Parents Last Name
Student/participant First Name
Student/participant Last Name
Students grade for 20-21 school year
K or under
None of the above
Name of club/activity/group/permit/community group/gym user group
Name of advisor/supervisor (or name of organization if a rental/permit/community group)
Date of Participation (First meeting day or Event)
Send me a copy of my responses.
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