Covid Consent and Protocol-Minors
Puget Sound Revels (PSR) COVID-19 Consent and Protocol
Protocols for children participating in In-Person events/performances/rehearsals

I, the undersigned Parent or Guardian, understand that COVID-19 (and variants) is highly contagious, can cause known, unknown, foreseen, and unforeseeable risks, and can be transmitted by asymptomatic carriers. I understand it poses health risks to those who contract it and those who come into contact with individuals who have contracted it; and that it poses a higher risk to certain individuals such as those with chronic medical conditions, are immunocompromised, are pregnant, and older adults. I understand the virus may cause symptoms including fever, cough, shortness of breath, mild to severe respiratory illness, and death. I understand that, while PSR is mitigating risk by following state health guidelines and protocols (including a vaccination requirement for those of age), PSR cannot eliminate all risk from the virus in any gathering (rehearsal or performance).

PSR rehearsal and performance protocols are as follows:

1. Before leaving the house for any PSR event parents/guardians will:
 • Take child’s temperature.
 • Ask child if they have any symptoms.
 • Ask child if they have been in contact with anyone with COVID-19.

 2. No one should attend an in-person PSR event if that person has any of the following possible signs of COVID-19 or has been in contact with anyone with symptoms or a positive COVID test:
 • Fever (100.4 or higher) or chills • Cough
 • Shortness of breath or difficulty breathing • Fatigue
 • Muscle or body aches • Headache
 • New loss of taste or smell 

Please contact PSR and let us know you will not be attending.

3. Masks and social distancing are required for all children, volunteers, and staff members in conformance with applicable Washington State and Pierce County guidelines.
4. Participants will bring all required materials to rehearsal and will not share personal items with other members (ie water bottles, phones, pencils, music, etc.)

5. Parents/guardians agree to communicate these protocols to their child/ward.

6. If my child/ward or an individual that my child/ward has been in close contact with is confirmed to have contracted COVID-19, my child/ward will not attend in-person PSR event until cleared by a physician.

7. This protocol is subject to change in conformance with changes in laws, orders, or guidelines from government authorities or health agencies.

Sign in to Google to save your progress. Learn more
Email *
Protocol Aknowledgement *
Parent/Guardian Name *
Child/Ward Name
Date *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Puget Sound Revels. Report Abuse