COVID-19 Disclosure and Liability Form (April 25th)

您的浏览器中未启用 JavaScript，因此无法打开此文件。请启用 JavaScript，然后重新加载。

The person signing this form hereby acknowledges and agrees that: (i) the information requested on this Form is being provided voluntarily, (ii) the information provided on this Form is confidential and is not intended for use outside of determining whether participation for an in-person event can occur, (iii) the refusal or failure to answer each question below may result in the denial of participation for in-person events; (iv) if the answer to questions 1-4 is “Yes” that person will not be permitted to attend the in-person event; (v) participants will be asked in the future to execute another Form in connection with future in-person events; and (vi) they must notify Five Borough Futbol Club, LLC if they become symptomatic and/ or test positive for COVID-19

电子邮件地址 *

Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has had symptoms of COVID-19? *

Yes

Have you tested positive for COVID-19 in the past 14 days? *

Yes

Have you experienced any symptoms of COVID-19 in the past 14 days? *

Yes

In the past 10 days, have you traveled from another state or country? *

Yes

Do you agree to comply fully with the 'Return to Play Guidelines'? You must select yes to play. *

Yes

必填

I understand that even with enhanced procedures to prevent the spread of COVID-19 described in the 'Return to Play Guidelines', I am still at risk of exposure. As such, I release Five Borough Futbol Club, LLC from any and all liability for unintentional exposure or harm due to COVID-19 or any other harms. You must select yes to play. *

Yes

必填

Please sign by typing your name

向我发送我的回复的副本。

提交

清除表单内容

切勿通过 Google 表单提交密码。

reCAPTCHA

隐私权条款

此内容不是由 Google 所创建，Google 不对其作任何担保。举报滥用行为 - 服务条款 - 隐私权政策

表单