STUDENT ACTIVITIES -COVID-19 PERMISSION FORM & WAIVER

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

Student First Name *

Student Last Name *

Activity the student is voluntarily attending/participating in (NOTE a Form must be filled out for each activity) *

Start Date of Activity *

YYYY

End Date of Activity *

YYYY

Coach/Sponsor *

I acknowledge that novel coronavirus (“COVID-19”) infections have been confirmed throughout the United States, including Missouri. I further acknowledge, agree, and represent that I have carefully considered the safety of allowing the above-referenced Student, for the purposes of participating in the above-referenced voluntary student activity, to enter onto District property; utilize District facilities, equipment, transportation and services; and/or interact with District staff and volunteers and students, for the purpose of participating in the above-referenced voluntary Student Activity. *

I acknowledge and understand the risks

I fully appreciate and understand both the known and potential dangers of allowing the above-referenced Student to participate in the above-referenced Student Activity, and acknowledge that such participation may, despite the District’s reasonable efforts to mitigate such dangers, result in exposure to COVID-19. If I have any questions regarding the known and potential dangers, I will contact the coach/sponsor identified above. *

I acknowledge and understand the risks

I agree, represent, and warrant that I will immediately notify the coach and/or activity sponsor if Student (i) experiences symptoms of COVID-19, including, without limitation, fever, cough, or shortness of breath, (ii) has a suspected or confirmed case of COVID-19, or (iii) has had exposure to any person that has a suspected or confirmed case of COVID-19. Student will not begin and/or resume participation in the Student Activity until Student’s return has been directly approved by the Student Activity coach and/or sponsor, and in the event of exposure or positive test, upon approval by a medical professional. I will also immediately notify the coach/sponsor above in the event Student obtains a positive COVID-19 test. *

I acknowledge and agree to notify the coach/sponsor

I hereby waive, release, and discharge the District, its insurers, employees, and all other entities affiliated with or related to the District, without limitation, exception, or reservation, from any and all liability, actions, claims, demands or lawsuits in connection with or arising in any manner out of Student’s participation in the above-referenced Student Activity during the COVID-19 pandemic and any subsequently-related exposure to COVID-19. *

I acknowledge and unequivocally agree to the above statement

Type your Students Full Name (First and Last) to Indicate you are digitally signing this document as their legal guardian giving them permission to voluntarily participate in the above--referenced student activity. (By typing your students name you understand this is a legal representation of their signature as their legal guardian). *

Type your Full Name (First and Last) as the students legal guardian to Indicate you are digitally signing this document. (By typing your name you understand: this is a legal representation of my signature). *

Date *

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Knob Noster R-VIII School District.

Does this form look suspicious? Report

Forms