2021 Girls PRACTICE Form
This form is required each day for each participant (Coaches and Players) using Seneca High School facilities, operated by the Lenape High School District. The form is automatically dated upon form submission. Each form submission applies to the day you hit the Submit button below, and it's valid for the whole day its dated for.
Please do not submit forms for future dates.
Only same day form submissions will be accepted.
Parent/Guardian Full Name
Parent/Guardian Cell Phone Number
Lenape High School High District COVID-19 Risk Acknowledgement and Acceptance Form
I (parent/guardian listed above) acknowledge and accept that the novel coronavirus (Covid-19) represents a potential serious health threat to persons exposed to it, and that each participant associated with the SENECA LACROSSE CLUB is relying on the truthfulness and accuracy of the certifications made by one another in every one of these forms completed by every participant.
I am certifying that to the best of my knowledge, information and belief that, at the time I have completed this form, NEITHER I NOR my child/player (if signing on behalf of one’s self and one’s child) nor any member of our household with whom we live:
- been diagnosed (tested positive) with Covid-19 within the past 14 days,
- a Covid-19 test pending,
- been placed under quarantine directed by a healthcare provider due to Covid-19 concerns,
- traveled in the past 14 days to anywhere designated by a State or Federal Authority as of today as being required or encouraged to self-quarantine for a 14 day period of time following reentry into New Jersey before engaging socially,
- traveled in the past 14 days to anywhere designated by the CDC as having a sustained widespread of Covid-19 as of today,
- had contact with someone diagnosed with Covid-19 within the last 14 days, or
- had contact with someone who had contact with someone diagnosed with Covid-19 within the last 14 days.
By signing and submitting this form, I also understand, acknowledge and accept the following:
- Lenape Regional High School District does not accept any liability for person(s) contracting Covid-19,
- I am responsible to myself, my family, the school district and community at large for protecting myself and others from spreading Covid-19 by always following safety and risk management protocols provided by the Federal and State governments and agencies, the school district and the organization I am involved with if separate from the school district,
- Temperature checks may be required by the school district ahead of each event for everyone present.
- Temperature checks may be conducted by my organization, a designee of the school district or the school district;
- Any temperature over 100.2 degrees Fahrenheit will result in being excluded from the activity and required to vacate school premises to seek medical attention.
- The school district has significant sanitization protocols designed to ensure the highest degree of safety and protection against the spread of Covid-19 and is doing everything a reasonable person should expect is being done for the purpose.
- I and my child, if applicable, have been provided the choice not to participate to avoid any possibility of being exposed to Covid-19 today and have chosen to participate being fully aware of the risk.
Acknowledgement and Acceptance
By checking this box - I confirm my acceptance of these terms and conditions.
THANK YOU from the Seneca Lacrosse Club
Send me a copy of my responses.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service