RVR Ultra Waiver and Health Declaration
All participants in Canadian River Valley Revenge must complete and submit this form, showing that you understand what you're getting into, that you know that you are responsible for yourself from start to finish, and that you meet all COVID-19 guideline requirements to participate.

This form MUST be completed and submitted on the date of your participation, no sooner no later (for compliance with COVID-19 guidelines).
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Section 1: Participant and Emergency Contact Information
Name (First, Last) *
Email *
Confirm Email *
Emergency Contact Name (First, Last) *
Emergency Contact Phone *
Confirm Emergency Contact Phone *
Section 2: Declaration of Health
Your privacy is important to us. Any information collected in this form will only be used or disclosed for the purpose of ensuring compliance with Alberta's and Canada's health guidelines during a pandemic, subject to Alberta's Public Health Act and Canada's Quarantine Act. All records will be destroyed after 30 days. For questions about your personal information, you may contact the the leadership at rvrultra@gmail.com, or the Office of the Information and Privacy Commissioner at www.oipc.ab.ca.
Do you have any conditions or accommodations, mental or physical, that you believe would be helpful to disclose?
I understand that the novel coronavirus (COVID-19) is highly contagious and has a long incubation period during which carriers of the virus may not show symptoms but still be contagious. *
Required
I confirm that I DO NOT have any of the following symptoms: fever, new cough or worsening of chronic cough, sore throat, shortness of breath, runny nose, loss of taste or smell. *
If you have any of these symptoms, you must stay home and get tested for COVID-19.
Required
I confirm that I DO NOT have any of the following symptoms: stuffy nose, painful swallowing, chills, headache, muscle or joint aches, fatigue or feeling unwell, nausea/vomiting/diarrhea/unexplained loss of appetite, conjunctivitis (pink eye). *
If you have any of these symptoms, you must stay home and self-isolate until the symptoms pass. Concerning symptoms would be those not typical for how you would normally feel when training for a race or doing other strenuous physical activity.
Required
I understand that there are categories of people who are considered high risk if exposed to COVID-19. Should I fall into one of the high risk categories, I understand and assume all risks as they relate to my participation in Canadian River Valley Revenge. *
High risk categories if exposed to COVID-19 are individuals 65 years or older, AND/OR those with pre-existing conditions such as heart disease, lung disease, kidney disease, diabetes, or an auto-immune disorder.
Required
I confirm that, to my knowledge, I am not currently positive for COVID-19. *
Required
I confirm that in the last 14 days, to my knowledge, I have not been in close contact with someone who has tested positive for COVID-19. *
Required
I confirm that I am not waiting for COVID-19 test results due to being in close contact with someone who tested positive, or because of identified risk factors. *
You do not have to confirm that you are asymptomatic and awaiting results if the above conditions do not apply to you.
Required
I confirm that, if I have travelled outside Canada in the last 14 days, I have finished the mandatory quarantine period. *
If you have returned from travel outside Canada after January 3rd, 2021, and you do not qualify for Alberta's Border Testing Pilot Program (https://travel.borderpilot.alberta.ca), you will still be in quarantine and unable to participate in Winter Revenge.
Required
I understand that I must maintain six feet (two metres) physical distancing from anyone who is not in my household cohort. *
Required
I understand that I must not mix and mingle in one spot with anyone who is not in my household cohort, even if we are six feet (two metres) apart. *
Required
I confirm that, if my work requires me to be in close contact with other individuals outside my household cohort, I have worn appropriate Personal Protective Equipment (PPE). *
Required
Section 3: Participant Liability Waiver and Release
I understand that participating in this activity involves potential and real risks, and that I should not participate unless I am physically able. I assume all risks associated with my participation including, but not limited, to, injuries or loss due to falls; physical impacts by others; and environmental harms caused by the weather, the surroundings, or the conditions of the terrain. I understand that the organizers may refuse or revoke my participation according to their policies and without reimbursement. In consideration of all this, I, for myself and for anyone entitled to act on my behalf, waive and release the City of Edmonton, Canadian River Valley Revenge, and its organizers, volunteers, sponsors, and other participants from all claims of liabilities arising from my participation, regardless of negligence or carelessness on the part of anyone named in this waiver and release.
*
Required
Participant Electronic Signature (type below) *
By electronically signing and dating this form, I agree to be bound by all of the clauses and conditions contained herein. (Electronic signatures are a valid form of signature, containing the same authority as a wet signature, subject to Alberta's Electronic Transactions Act.)
Date of Participant's Signature: *
MM
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Parent/Guardian Electronic Signature (type below)
Must be signed by a parent or guardian if the participant is under 18 years old.
Date of Parent/Guardian's Signature
MM
/
DD
/
YYYY
Media Notice
I understand that Canadian River Valley Revenge may collect and use images of me for marketing or promotional purposes. Any images of me taken by RVR Ultra may be provided to me free of charge and at my request.
Thank you for your time and support. (That was Long!)
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