Hana Hou Volleyball Club User Waiver & Self-Screening
Please submit this form each time you come to the gym.  
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Email *
Your Last Name *
Your First Name *
Phone Number ( with area code) *
Your Temperature today (must be less than 99.9) *
If you are experiencing any symptoms of illness, do NOT participate in the activity at the gym. *
Required
If the participant has been in contact with someone under investigation for, or with a confirmed case of COVID-19, please stay HOME . *
Required
If you have traveled out of state within past 30 days, please stay home.   *
Required
I agree and acknowledge that my participation in the activities with the Hana Hou Volleyball Club may involve inherent dangers and risks including, without limitation, the risk of exposure to, and/or illness resulting from, novel coronavirus ("COVID-19"), and I knowingly and voluntarily assume all such risks and release the Hana Hou Volleyball Club and all its representatives from any liability whatsoever. I attest  to the fact that the information above is correct.   I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT AND FULLY UNDERSTAND ITS TERMS. I ALSO UNDERSTAND THAT I HAVE GIVEN UP CERTAIN RIGHTS BY SIGNING IT, AS DESCRIBED ABOVE, WHICH I AGREE TO DO VOLUNTARILY. I ATTEST THAT THE INFORMATION PROVIDED IS TRUE.                                     Print full name of participant or parent. *
Today's Date *
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