HVAC Daily Admittance Form
Please complete once each day you visit HVAC Facilities. If you answer yes to any of the following questions you are not permitted to enter the complex. Thank you.
Email address *
Name *
Phone Number *
Have you been diagnosed with COVID-19 within the past 14 days? *
Have you had close contact with or cared for someone who has tested positive for COVID-19 within the past 14 days? *
Have you been in close contact with a suspected case of COVID-19 within the past 14 days? *
Have you experienced any of the following symptoms in the last 14 days? *
yes
no
Fever or chills
Dry cough
Difficulty breathing or shortness of breath
Fatigue
Muscle or body aches
Sore throat
Headache
Congestion or runny nose
Nausea or vomiting
Diarrhea
New loss of taste or smell
Signature *
RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT (“AGREEMENT”) In consideration of my use of facilities and/or services provided at Huron Valley Athletic Complex at 201 Lone Tree Rd., Milford, MI 48380 I represent that I understand the nature of this Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the Activity.I fully understand that this Activity involves risks of serious bodily injury, including permanent disability, paralysis, and death, which my be caused by my own actions, or inaction, those of other participants in the event, the conditions in which the event takes place, or the negligence of the “releasees” named below; and that there may be other risks either responsibility for losses, costs, and damages I incur as a result of my participation in the Activity.I hereby release, discharge and covenant not to sue Huron Valley Athletic Complex, 201 Lone Tree LLC, its respective administrators, directors, agents, officers, volunteers, umpires, referees and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered on of the “RELEASEES” herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “releasees” or otherwise, including negligent rescue operations; and I further agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save and hold harmless each of the releasees from any loss, liability, damage, or cost which any may incur as the result of such claim.I give Huron Valley Athletic Complex irrevocable consent to release photographs, slides, moving pictures, and audio/visual material of the above-named child for records, public relations and/or advertising, videos, voice or text material, and either with or without my child’s name or photo accompanying quotation.I have read the RELEASE AND WAIVER OR LIABILITY, ASSUMPTION OF RISK, AND INDEMINTY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extend allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in the full force and effect. This agreement is effective at all times subsequent to the date of its execution unless rescinded by an express writing sent to the above address by certified mail. *
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