COVID-19 Daily Attestation Form for Varsity Performance Karate Participants
Participants name *
Today's Date *
Guardian/parent's name if the participant is a minor.
By agreeing to each statement below, the Participant or the Participant’s Guardian attests that the Participant:
1. Does not knowingly have COVID-19; Is not experiencing any known symptoms of COVID-19, such as fever, cough, shortness of breath or malaise; *
2. Has not traveled internationally during the past 14 days; *
3. Has not frequented a COVID-19 high risk area in the Province during the last 14 days; *
4. Has not, in the past 14 days, knowingly come into contact with someone who has COVID-19, who has known symptoms of COVID-19, or is self-quarantining after returning to Canada; *
5. Has been following government recommended guidelines in respect of COVID-19, including practicing physical distancing. *
Furthermore, by signing below, the Participant or the Participant’s Guardian agrees that while attending or participating in the Organization's events or attending at the Organization’s facilities, the Participant:
1) Will follow the guidelines and protocols mandated by the Varsity Performance Karate with respect to COVID-19. *
2) Will, in the event that the Participant experiences any symptoms of illness such as a fever, cough, difficulty breathing, shortness of breath, or malaise, immediately: inform a representative of the Varsity Performance Karate; and depart from the facility. *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy