DAILY ATTESTATION WAIVER for Southwest Zone Youth Basketball Association
hereafter referred to as the "SWZYBA"
DAILY COVID-19 ATTESTATION AND AGREEMENT
"Event" Scope: any singular SWZYBA sponsored practice, game, or training session.
PLEASE NOTE: This attestation needs to be completed for every day that the participant is attending a SWZYBA sponsored event (practice, game, or training session)
By signing below, the Participant (named below) or the Participant’s Guardian attests that the Participant: *
You must truthfully confirm all of the below statements regarding the participant. If you cannot, you should withdraw your participation from the event until such time as you can truthfully confirm.
Confirm
Does not knowingly have COVID-19;
Is not experiencing any known symptoms of COVID-19, such as fever, cough, shortness of breath or malaise
Has not travelled outside of Canada in the last 14 days;
Has not frequented a COVID-19 high risk area in the Province during the last 14 days;
Has not, in the past 14 days, knowingly come into contact with someone who has COVID-19, who has known symptoms of COVID-19, or is self-quarantining after returning to Canada; and
The attendee has not had close contact with a symptomatic* close contact of a confirmed case of COVID-19 in the last 14 days? * ‘Ill/symptomatic’ means someone with COVID-19 symptoms on the list above.
Has been following government recommended guidelines in respect of COVID-19, including practicing physical distancing.
Furthermore, by signing below, the Participant or the Participant’s Guardian agrees that while attending or participating in theSWZYBA's events or attending at the SWZYBA’s facilities, the Participant: *
Confirm
Will follow the laws, recommended guidelines, and protocols issued by the Government of the Province in respect of COVID-19, including practicing physical distancing, and will do so to the best of the Participant’s ability while participating in the SWZYBA's events or attending at the SWZYBA’s facilities;
Will follow the guidelines and protocols mandated by the SWZYBA in respect of COVID-19;
Will, in the event that the Participant experiences any symptoms of illness such as a fever, cough, difficulty breathing, shortness of breath or malaise, immediately: A) inform a representative of the SWZYBA; and B) depart from the event or facility.
FOR PARTICIPANTS WHO HAVE BEEN DIAGNOSED WITH COVID-19
By signing below, the Participant (named below) or the Participant or the Participant’s Guardian attests that the Participant has been diagnosed with COVID-19, but been cleared as non contagious by provincial or local public health authorities and has provided to the SWZYBA, in conjunction with this COVID-19 ATTESTATION AND AGREEMENT, written confirmation from a medical doctor of the same.
DO NOT check this box unless the participant has been diagnosed with COVID-19. In the case of undiagnosed symptoms please refrain from attending any activity.
Participant's Full Name *
Please enter the first and last name of the participant.
Participant's Birth Date *
MM
/
DD
/
YYYY
Guardian's Full Name *
Please enter the first and last name of the guardian. If the participant is of the age of majority, enter "N/A".
Digital Signature
I confirm that I understand that by clicking on, or tapping on "submit", I am providing electronic acknowledgement of consent equivalent to that given by written signature on paper. *
Required
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