HLC 2021 COVID Screener
To be allowed to participate on behalf of Hopkinton Lacrosse Club athletic program and related events and activities, the undersigned acknowledges, appreciates, agrees and understands that:
1. EVERY week (on Sunday), EACH participant will be required to have a symptom free COVID-19 waiver signed by an adult BEFORE participating. (Completing this form fulfills this requirement)
2. At EVERY session, EACH participant will be required to complete a temperature check BEFORE participating.
3. At EVERY session EACH participant will be required to wear a mask at all times.
4. At EVERY session EACH participant will be verbally asked the three screening questions below.
5. ALL participants and ANYONE spectating understand(s) that HLC will enforce the social distancing guidelines put in effect by the Centers for Disease Control (CDC) and/or NH Dept. of Health and Human Services (DHHS).
6. ALL participants and ANYONE spectating understand(s) that they will be required to be in accordance with mask use and social distancing guidelines set forth by the CDC and/or NH Dept. of Health and Human Services (DHHS).
7. ALL participants and ANYONE spectating understands that they may be asked to leave if they are not in accordance with the social distancing guidelines put in effect by the CDC and/or NH Dept. of Health and Human Services (DHHS)..
8. There will be no sharing of equipment during practices and/or games (except for game/ practice balls).
9. Families and athletes will immediately exit the field and/or facility of use.
10. Families and athletes will not congregate following practices and/or games.
11. Families and athletes will clean/disinfect all uniforms, apparel, and equipment immediately after practices and/or games (this includes all lacrosse equipment to the best extent possible).
12. Hand washing and hand sanitizing is required by all athletes and coaches at the beginning and of each team meeting/activity.
13. Athletes will bring their own bottles and water and personal water bottles shall not be shared with other athletes.
14. There shall be no sharing of food or other type products among and between athletes.
15. The participant/participant’s guardian are responsible but not limited to the following:
Checking their emails for important updates, changes, and alerts.
Opting in and checking text messages for important updates, and alerts.
Checking the HLC’s Webpage regularly for updates, changes and alerts at
16. A new signed and completed COVID-19 Guideline Waiver Form will be required for each week (starting on Sunday), in order for a participant to participate and any changes in status should be reported as soon as possible to the head coach. (Completing this form fulfills this requirement)
By submitting this form:
This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.
Athlete Name (First & Last)
Parent Name (First & Last)
Does the athlete have signs or symptoms of a respiratory infection, such as fever above 100°, cough, shortness of breath, sore throat, muscle aches/pain, headache, fatigue, vomiting, nausea, diarrhea, or a new loss of taste or smell?
In the last 10 days, has the athlete had close contact with a person with a confirmed diagnosis, or is presumed positive for COVID, or is ill with a respiratory illness?
Has the athlete traveled internationally or on a cruise ship in the past 10 days?
Send me a copy of my responses.
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