Outside/Community Covid-19 Waiver and Release for Minnetonka School District
Consistent with Executive Order 20-56, Minnetonka Public Schools will begin allowing limited access to its indoor and outdoor facilities.
All users, groups, and individuals must adhere to the Minnesota Department of Health Guidelines for youth sports. Guidelines for interactions, skill work, and sizes of the pods (25 or less) per field/facility are outlined in this document:
However, even with caution and preventative measures, an inherent risk of exposure to COVID-19 exists in any public setting where people from different households are present. COVID-19 is an extremely contagious disease that can be transmitted even by people who are asymptomatic and can lead to serious illness and death. By accessing the District’s fields and indoor facilities, you and your child voluntarily assume all risks related to exposure of COVID-19.
**By signing (or electronic submission via email) below, I acknowledge that I understand the inherent risks associated with exposure to COVID-19 and am voluntarily assuming such risks in order for me and/or my child to utilize the District’s facilities. I hereby release and waive, and further agree to indemnify, hold harmless, or reimburse the School District and its individual board members, agents, employees, and representatives, from and against any claim which I, my child, or any other party, may have or claim to have, for any losses, damages, or injuries arising out of or relating to exposure to COVID-19 in connection with my or my child’s access to district facilities.**
**Participant or parent/guardian or coach certifies that they will comply with any applicable Executive Order from the Governor of Minnesota regarding field use or indoor facilities**
**Participant and parent/guardian understands that if participant displays any of the symptoms of Covid-19 they are NOT to attend activities on ISD 276 facilities and must quarantine for 14 days. For symptoms:
If you do not complete this form you are not permitted to use ISD 276 facilities.
We/I agree to all of the above information. (If you cannot answer 'Yes' you are unable to use district facilities or participate in programming using district facilities)
WE/I understand the signs and symptoms of Covid-19 and will NOT attend ISD 276 facilities if any of them are present in the participant. This includes daily temperature monitoring as the participants responsibility. Symptoms can be found:
(If you cannot answer 'Yes' you are unable to use district facilities or participate in programming using district facilities)
Parents First Name
Parents Last Name
Student/participant First Name
Student/participant Last Name
Students grade for 20-21 school year
None of the above
Date of Participation (First day on campus)
Organization or Group (outside of MHS) ***If you are involved in multiple groups you must submit this form one time for each group you are involved with.
America Legion Opponent (Visitors)
Jeff Trickey Football Camp July 2-3
Jeff Tricky Football Camp July 13-14
Jeff Trickey Youth Camp July 13
Jeff Trickey Advanced Camp July 24-26
KARE 11 Prep Sports Extra (Football)
Minnetonka Baseball Association
Minnetonka Millers Opponent (Visitors)
Minnetonka Lacrosse Association
Minnetonka Youth Softball
Minnetonka Youth Softball (Visitors)
Pagel Adult Skate
Theatre Camp 4-9
Theatre Camp 10-12
Tonka United Soccer
Tonka Football Association
Visitor (my participant is a visitor to MHS)
None of the above
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of Minnetonka Public Schools Google Apps.