WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19
ASSUMPTION OF RISK/ WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT
In consideration of being allowed to participate on behalf of Mokena Youth Athletic Association and related events and activities, the undersigned acknowledges, appreciates, and agrees that:
1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING
FROM THE NEGLIGENCE OF THE ("RELEASEES") or others, and assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards
protection against infectious diseases. II, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE
AND HOLD HARMLESS Mokena Youth Athletic Association their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage of person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
Email *
Participant First and Last Name *
Participant Date of Birth *
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I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, sign it freely and voluntarily without without any inducement. *
Name of Parent / Guardian *
Have you (the participant) felt feverish? *
Do you (the participant) have a cough? *
Do you (the participant) have a sore throat? *
Have you (the participant) experienced any difficulty breathing or shortness of breath? *
Do you (the participant) have any muscle aches? *
Have you (the participant) had a new or unusual headache (e.g., not related to caffeine, diet, or hunger, not related to history or migraines, clusters, or tension, not typical to the individual)? *
Have you (the participant) noticed a new loss of taste or smell? *
Have you (the participant) been experiencing chills or rigors? *
(Rigors: a sudden feeling of cold with shivering accompanied by a rise in temperature)
Do you (the participant) have any gastrointestinal concerns (e.g., abdominal, pain, vomiting, diarrhea)? *
Is anyone in your household displaying any symptoms of COVID-19? *
I will inform MYAA if I knowingly come in contact with someone who tested positive for COVID-19 within the past 14 days. I will also inform MYAA and not attend MYAA activities for 14 days if I develop any of the above symptoms. If I test positive for COVID-19, I will not return to MYAA activities without medical clearance. *
If you answered YES to any of the questions, you will not allowed to participate. By selecting the AGREE button you are indicating that the participant is able to participate and that you agree to ASSUMPTION OF RISK/ WAIVER OF LIABILITY /INDEMNIFICATION AGREEMENT, PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION), and WELLNESS CHECKLIST *
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