Action Athletics COVID-19 Release & Health Evaluation

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In accordance with the Centers for Disease Control (CDC) and to prevent the spread of COVID-19, Action Athletics is screening all participants for certain risk factors before entrance is allowed. If the form cannot be completed, please email us at info@action-athetlics.com. The form must be completed no more than 48 hours before your participation date. If any information changes after submitting this form, please email us to let us know.

Please see our website for updated COVID 19 policies. http://www.action-athletics.com

Participant's First Name *

Participant's Last Name *

Participation Date (not birthday) *

YYYY

COVID WAIVER ADDENDUM *

I acknowledge, understand, and agree that I am voluntarily allowing my child to participate in programs and activities offered by Action Athletics knowing that participation may result in possible exposure to and illness from infectious diseases, including, but not limited to, MRSA, Influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases of others, and assume full responsibility for my participation and exposure.

I acknowledge, understand, and agree to allow my child to be spotted when spotting is absolutely necessary.

I acknowledge that I have reviewed all policies and I understand that failure to follow the rules may result in revocation of all privileges provided by Action Athletics without refund of any prepaid fees. http://www.action-athletics.com/covid-policies.html

Required

COVID HEALTH EVALUATION - SYMPTOMS *

In the past 14 days, participant has NOT experienced:

A fever above 100.4

Cough, sore throat, congestion, fatigue, or shortness of breath

Headache or muscle/joint pain

Nausea/vomiting/diarrhea/stomach ache

Loss of smell or taste or loss of appetite

Required

COIVD HEALTH EVALUATION - OTHER *

Participant has not been directed to quarantine due to either testing positive for COVID-19, having a pending COVID-19 test result, or being named as a close contact.

Participant has not been in contact with anyone who has tested positive for COVID-19, or having been in contact with someone who has been sick or had signs or symptoms of COVID-19 (listed above) within the past 14 days.

Participant has not traveled to any country or state currently designated as a high-risk location in the past 14 days. Effective March 22, 2021, all visitors and returning residents entering MA are advised to follow the Commonwealth's new travel advisory. https://www.mass.gov/info-details/covid-19-travel-advisory

Participant will submit to and pass a temperature check upon entry.

Required

Parent or Guardian Signature *

Please type your name as your signature agreeing that the above information is accurate. If anything changes after filling out this form, please email or call us.

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