COVID-19 WAVIER | MY TEAM HOCKEY

Covid-19 Health Declaration

How are you feeling today?

First Name (Parent/Guardian)

Last Name (Parent/Guardian)

First Name (Child)

Last Name (Child)

Vaccinated (Check the box for YES or leave blank)

Patrick Murphy operating as My Team Hockey (“MTH”) recognizes the World Health Organization’s declaration that the novel Coronavirus (COVID-19) is a worldwide pandemic. In accordance with the recommendations set-forth by the government and in an effort to combat the spread of Covid19 MTH is required to comply with certain regulations and guidelines in relation to your participation in our hockey program (the “Activity”). Notwithstanding our efforts to follow the government’s guidance in the delivery of the Activity, we cannot guarantee that you will not be exposed to Covid19 as a result of your participation in the Activity. For that reason, we require the undersigned to complete and sign the following Declaration and Waiver (the “Waiver”). By clicking beside each of the following bullet points I confirm my response in the affirmative to the statement, as indicated by the checkmark.

My body temperature is lower than 98.6°F/ 37.5°C and I am not experiencing the symptoms: fever, cough, sore throat or difficulty breathing.

I have not, nor any member (s) of my houseold, traveled outside Canada in the last 14 days. (This does not include essential workers who cross CAN/US border regularly or under 72 hour visits to the US).

I have not been in close contact with a Covid-19 patient or someone who is being tested for exhibited symptoms of COVID-19 in the last 14 days that resulted in a postive test.

I am aware of the existence of the risk to my health by my participation in the Activity, including the risk of contracting COVID-19 which may result in injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to, among other things, paralysis or death and that I may spread the COVID-19 virus to others who may suffer similarly.

With full knowledge of the risks involved, I hereby release, and waive and discharge MTH, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or relates to any loss, damage, injury, or death that may be sustained by me or anyone claiming through me related to COVID-19 as a result of my participation in the Activity while in, or around the premises or while using the facilities used in connection with the Activity that may lead to unintentional exposure or harm due to COVID-19.

I agree to indemnify, defend and hold harmless MTH, employees representatives, successors, and assigns from and against any and all costs, expenses, damages, lawsuits, and or/liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against MTH, employees representatives, successors, and assigns due to injury, loss, or death from or related to COVID-19 associated with my participation in the Activity.

Initials (Parent/Gurdian/Adult over 18)

Date

I declare that the info I’ve provided is accurate & complete. I, the undersigned parent or legal gaurdian of the child(ren) shown above, have read and understand the above COVID-19 Liability Relase Waiver and agree to its terms on behalf of my child(ren) and myself.

Your Signature

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