Flag Cheer St. Bart's Buffalos COVID Checklist Survey

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Please fill this out everyday before practice.

Player's Name *

Association's Name *

Team Name *

Have you been in close contact with any person that has tested positive for COVID-19 in the past 14 days? *

Yes

Are you experiencing any new or worsening symptoms of possible COVID-19? *

Cough

Shortness of breath/Difficulty breathing

Chills

Repeated shaking with chills

Muscle pains

Headache

Sore throat

Loss of taste or smell

Diarrhea

Feeling feverish or have a temperature equal to or greater than 100 degrees Fahrenheit

Currently living with someone his has symptoms of COVID-19

None of the above/No Symptoms

Required

Temperature Certification - I certify that I took my temperature before arrive at the field today and it was less that 100 degrees fahrenheit. *

Yes

Duty to Inform: I will inform you if I knowingly come in contact with someone who tested positive within 14 days prior. I will inform you and not attend NJAYF activities for 14 days if I develop any of the above symptoms. If I test positive for COVID-19, I will not return to NJAYF activities without medical clearance.COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread from person-to-person contact. Federal, state, and local governments and health agencies recommend social distancing and have, in many areas, prohibited group activities. NJAYF and your local association are taking steps to reduce the spread of COVID-19;however,NJAYF or your local association cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attendingNJAYF activities could increase the risk of contracting COVID-19.By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I maybe exposed to or infected by COVID-19 by attending NJAYF/Local Association activities and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID19 may result from the act, omission, or negligence of myself and others, including, but not limited to, NJAYF/Local Association volunteers, and other participants and their families.I voluntarily agree to assume the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may incur by reason of NJAYF/Local Association activity (“Claims”). On my behalf, and on behalf of my children, I hereby release and covenant not to sue NJAYF, its affiliated organizations, employees, volunteers, agents, and representatives, of and from the Claims. *

Yes

Parent/Guardian Electronic Signature *

Date *

YYYY

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