MUKILTEO LOCATION WELLNESS FORM
To ensure that we maintain a safe and healthy environment, we request that everyone fill out this wellness form before entering the gym.

Any member who played at the gym and is later found to be COVID-19 positive is to report to our staff immediately.  All members who played at the same time as this positive player will be contacted and recommended to quarantine for 14 days.

I CONFIRM I AM:

NOT EXPERIENCING COUGH, SHORTNESS OF BREATH, OR SORE THROAT.

NOT HAD A FEVER IN THE LAST 48 HOURS.

NOT EXPERIENCE TASTE LOST OR SMELL.

NOT VOMITTED OR HAD DIARRHEA IN THE LAST 24 HOURS.

NOT BEEN IN CLOSE CONTACT WITH A CONFIRMED CASE OF COVID-19 IN THE LAST 14 DAYS.

NOT DIAGNOSED WITH ASTHMA.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren), my family, and I may be exposed to or infected by COVID-19 by attending the Bellevue Badminton Club and its locations 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 COVID-19 at the Bellevue Badminton Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Bellevue Badminton Club employees, volunteers, and program participants and their families.

High-risk groups such as, but not limited to those with diabetes, asthma, obesity, cancer, immune deficiency, currently pregnant, those who regularly smoke, or those who are over the age of 65 may experience more severe symptoms from COVID-19. I acknowledge that if my child(ren) or I are in a high-risk group then the symptoms associated with contracting COVID-19 may be greater.

I voluntarily agree to assume all of 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 experience or incur in connection with my child(ren)’s attendance at the Club or participation in Club programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.

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First and Last Name of Person Entering *
First and Last name of Parent or Legal Guardian if the person entering is under the age of 18.
What is your email address? *
What court are you on? (Check Ballbutton app)(If ladder or training, please write any number) *
Are you fully vaccinated?
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I confirm I have read and do not have any of the symptoms and agree to all that is listed and written above. *
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