Covid-19 Screener Form
Must be completed prior to arrival to event
I will adhere to the Mask wearing requirement *
I will adhere to County Guidelines of limiting spectators to household members *
Time Symptom Check Completed *
Time
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Today's Date *
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DD
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Athlete First Name *
Athlete Last Name *
Division *
Coaches Name *
Temperature *
Fever (CDC considers anything above 100.4 to be a fever) *
Feel Sick *
Have the Chills *
Cough *
Sore Throat *
Shortness of Breath *
New loss of taste or smell *
Muscle Pain *
If you have two or more of these symptoms please stay home and continue to monitor
Recent Close contact w/someone with COVID-19 *
Freedom Lacrosse Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 -----------------------------------------------------------------------The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Freedom Lacrosse has put in place preventative measures to reduce the spread of COVID-19; however, Freedom Lacrosse cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending a Freedom Lacrosse function could increase your risk and your child(ren)’s risk of contracting COVID-19. -------------------------------------------------------------By agreeing to this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending any Freedom Lacrosse function and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at any Freedom Lacrosse function may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Freedom Lacrosse, employees, subcontractors, coaches, agents, representatives, and owners of rental fields/properties. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance to any Freedom Lacrosse function (“Claims”). On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless Freedom Lacrosse, its employees, subcontractors, coaches, agents, representatives, and owners of rental fields/properties of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Freedom Lacrosse, employees, subcontractors, coaches, agents, representatives, and owners of rental fields/properties, whether a COVID-19 infection occurs before, during, or after participation in any Freedom Lacrosse function. I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE: * *
I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Release. (Print Full Name) *
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