COMMUNICABLE DISEASES PARTICIPANT (ATHLETE AND VOLUNTEER) RISK ASSESSMENT, CODE OF CONDUCT, AND WAIVER
DIRECTIONS: The COMMUNICABLE DISEASES PARTICIPANT (ATHLETE AND VOLUNTEER) RISK ASSESSMENT, CODE OF CONDUCT AND WAIVER must be electronically signed and submitted via Google Forms by every participant (athletes, Unified partners, coaches, volunteers, family members, caregivers or others in attendance of an activity) prior to the start of the in-person activity. The form has 3 sections (Risk Assessment, Code of Conduct and Waiver) and must be completed in one-sitting as you cannot return to the form.
If a participant does not have access to submit electronically or ability to send a photo of the completed form to the site COVID-19 Coordinator, participant must schedule a call with the site COVID-19 Coordinator at least 24 hours prior to the first in-person activity to verbally provide their answers to the site COVID-19 Coordinator.
• Site COVID-19 Coordinator will enter form electronically based on information provided by participant.
• Participant must bring a completed paper form to the first in-person activity and provide to the site COVID-19 Coordinator upon arrival at first in-person activity.
• Site COVID-19 Coordinator will send that form to Chelsea Hammell
Please reach out to your SOPA Field Director with any questions that you may have.
I understand I could get Coronavirus through in-person sports, training, competition and/or any group activity at Special Olympics Pennsylvania. I am choosing to participate in sports, training, competition and/or other Special Olympics Pennsylvania activities at my own risk.
First name of participant?
Last name of participant?
Are you vaccinated?
If you are vaccinated, which vaccine have you received?
Johnson & Johnson
I am NOT vaccinated
If you are vaccinated what dose number have you received?
I am NOT vaccinated
Who is the site COVID-19 Coordinator (Type their name below)?
Site Location of training or meeting/social gathering (EXAMPLE: Smith Elementary, Everhart Park)?
Participant activity type?
Long Distance Running/Walking
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