Declaration of Health Form - for GVOC events
Orienteering Canada, its provincial/territorial associations and affiliated clubs (collectively the “Organization”) require the disclosure of exposure or illness is in order to safeguard the health and safety of all participants and limit the further spread of COVID-19. This Declaration of Health will be kept safely, and personal information
will not be disclosed unless as required by law or with your consent.
An individual (or the individual’s parent/guardian, if the individual is younger than the age of majority) who is unable to agree to the terms outlined in this document is not permitted to participate in the Organization’s activities, programs, or services.
I, the undersigned being the individual named above and the individual’s parent/guardian (if the individual is younger than the age of majority), hereby acknowledge and agree to the terms outlined in this document:
1) The coronavirus disease COVID-19 has been declared a worldwide pandemic by the World Health Organization and COVID-19 is extremely contagious. The Organization has put in place preventative measures to reduce the spread of COVID-19 and requires all individuals (or their parent/guardian, when applicable)
to adhere to the compliance standards described in this document.
2) The individual has not been diagnosed with COVID-19. OR If the individual was diagnosed with COVID-19, the individual was cleared as noncontagious by provincial or local public health authorities.
3) If the individual is a front-line worker (such as hospital staff, long term care staff, or other individual who interacts with individuals who have confirmed or suspected cases of COVID-19), the individual has worn proper and approved Personal Protective Equipment at all times whenever they interacted with an
individual who has a confirmed or suspected case of COVID-19 in the last 10 days.
4) If the individual is not a front-line worker, or other individual who interacts with individuals who have confirmed or suspected cases of COVID-19, they have not been exposed to a person with a confirmed or suspected case of COVID-19 in the last 10 days.
5) The individual is attending or participating voluntarily and understands the risks associated with COVID-19. The individual (or the individual’s parent/guardian, on behalf of the individual (when applicable)) agrees to assume those risks, including but not limited to exposure and being infected.
6) The individual has not, nor has anyone in the individual’s household, experienced any signs or symptoms of COVID-19 in the last 10 days (including fever, new or worsening cough, fatigue, chills and body aches, respiratory illness, difficulty breathing, nausea, vomiting or diarrhea, pink eye, or loss of taste or smell) that are not related to other known causes or conditions you already have.
7) If the individual experiences, or if anyone in the individual’s household experiences, any signs or symptoms of COVID-19 after submitting this Declaration of Health, the individual will immediately isolate and follow the procedures set out by the relevant public health authority.
8) The individual and all members of the individual’s household has followed all local, provincial, and federal government rules regarding travel both domestically and internationally with regards to travel, quarantine and re-entry.
9) The individual is following recommended guidelines, including but not limited to, practicing physical distancing, trying to maintain separation of two metres from others, adhering to recognized hygiene best practices, and otherwise limiting exposure to COVID-19.
10) The individual will follow the safety, physical distancing and hygiene protocols of the Organization.
11) The individual will bring their own personal items and personal equipment (such as water bottles, bags, towels, etc.) at their discretion and will not share their personal items or equipment with other individuals.
12) The requirement to sign this document each day the individual participates will remain in effect until the Organization determines that the acknowledgements in this Declaration of Health are no longer required.
13) The Organization may remove the individual from participating in the activities, programs or services of the Organization at any time and for any reason if the Organization believes, in its sole discretion, that the individual is no longer in compliance with any of the standards described in this document.
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Individual's Full Name (first, last)
Name of Parent / Guardian (if individual is under 18 years old):
Electronically Signed and Submitted by: *Each individual (or Parent/Guardian if under 18 years of age) must type their name below and click the Submit button, which will record the date and other details entered above. By entering your name, you are electronically signing the document and verifying that you have read and agree to the terms and conditions above.
A copy of your responses will be emailed to the address you provided.
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