COVID Release Form
Client and/or Parents are aware of the current outbreak of the Covid-19 virus (Coronavirus), classified by the World Health Organization (WHO) as a pandemic, which may pose an adverse impact to clients’ health and safety. In order to participate in the services offered by EMPACT Tennis & Sport Performance, LLC I agree to the following:
Participant will not come to the lesson/camp/clinic/program if they have a fever or have had any of these symptoms for last 21 days:
- Fever of greater than 100.4
- Shortness of Breath
- Loss of sense of smell or taste
- Severe headache
- Sore throat
Participant will not come to the camp/clinic/program for 21 days if I test positive for Covid-19.
Participant will not come to the camp/clinic/program if I come in close contact with someone who has been quarantined, tested or diagnosed with Covid-19 in the past 14 days.
Participant will maintain social distance as much as possible.
Participant will bring a mask to camp/clinic/program and agree to wear it during any indoor activities as long as it is recommended to do so by local authorities or EMPACT Tennis & Sport Performance, LLC.
**Close is defined as a) being within approximately 6 feet of a person with Covid-19 (such as caring for or visiting the patient; or sitting within 6 feet of the patient b) being coughed on, touching used tissues, etc.
Acknowledgement of Terms Agreement
I have read the preceding and acknowledge full understanding of its terms and those risks set forth herein and I knowingly agree to accept full responsibility for my own exposure to such risks and to waive full responsibility and liability on behalf of EMPACT Tennis & Sport Performance, LLC, and its employees. I understand the policies and procedures set forth by EMPACT Tennis & Sport Performance, LLC. and have had the opportunity to discuss my specific needs in relation to participatory activity and, as a result, I do knowingly and voluntarily request the right to participate in this preventive program of exercise. I sign this agreement voluntarily and with full knowledge of its significance.
Youth Participant’s Name
Adult Participant's/Parent’s Name
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