ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT FOR COVID-19
January 26, 2021
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Email *
First and Last Name of Student Athlete *
HS of Attendance *
In consideration of allowing the above identified minor being allowed to participate in after school athletic activities offered by the Mount Diablo Unified School District, please initial 1-5 then sign and date the bottom.  
1.  I understand, acknowledge and agree that the District, its employees, officers, agents or     volunteers shall not be liable for any injury/illness suffered by my son/daughter which is          incident to and/or associated with preparing for and/or participating in this activity and I        voluntarily assume all risk, known or unknown, of injuries, howsoever caused, even if caused      in whole or in part by the action, inaction, or negligence, of the released parties to the fullest      extent allowed by law. *
2.  Participation includes possible exposure to and illness from infectious diseases including     but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist *
3.  I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my Player/Student’s participation. *
4.  I willingly agree to comply with the stated and customary terms and conditions for     participation as regards protection against infectious diseases. I have reviewed the most        recent directives from the Centers for Disease Control (CDC), the California Department of      Public Health and Contra Costa Health Services regarding the risks associated with Covid-19      exposure and safe practices to follow. If, however, I observe and any unusual or significant      hazard during my presence or based on information provided to me I will remove my Player/Student from participation and bring such to the attention of the nearest official immediately. Further I have informed and discussed the dangers of participation and the      required rules and regulations to allow participation to my Player/Student and he/she acknowledges a full understanding of such. *
5.  I, for myself and on behalf of my Player/Student, heirs, assigns, personal and  representatives HEREBY RELEASE AND HOLD HARMLESS the Mount Diablo Unified School District, its officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to    conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS,  DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. *
Electronic Signature for Parent Guardian *
Date of Signature *
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