Howell Rebels Football COVID-19 Waiver

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Must Be Completed Within 2 Hours Before Any Team Activity Daily !

What Is Your Athletes Name ? ( Last, First ) *

What Team Is Your Athlete On ? *

Flag Blue

Flag White

7 & Under

8 & Under

9 & Under

11 & Under

12 & Under

Have You Been In Close Contact With Any Person ( Within 6 feet for more 10 minutes )That Has Tested Positive For CODID-19 In The Past 10 Days ? *

Yes

Are You Experiencing Any New or Worsening Symptoms of Possible COVID-19 ? *

Cough ?

Shortness Of Breath/Difficulty Breathing ?

Repeated Shaking & Chills ?

Muscle Pain ?

Headache ?

Sore Throat ?

Loss Of Taste or Smell ?

Feeling Feverish or Have A Temperature Greater Then 100 Degrees Fahrenheit

NONE OF THE ABOVE / NO SYMPTOMS

Required

Do You Have Someone In Your Household That Has Symptoms of Covid-19 or Been Diagnosed With Covid *

YES

Have You Taken Any Fever Reducing Medication ? *

Yes

Do You Certify That You Took Your Athletes Temperature Before Arriving at the team activity Today And It Was Less Then 100 Degrees Fahrenheit ? * *

Yes

Duty to Inform: I will inform you if I knowingly come in contact with someone who tested positive within 10 days prior. I will inform you and not attend Howell AYFC activities for 10 days if I develop any symptoms related to COVID-19. I will not return to Howell AYFC activities without a medical clearance. COVID-19 has been declared as a world-wide pandemic by the World Health Organization. COVID-19 is extremely contagious and it is believed to spread person-to-person contact. Federal, state, and local governments and health agencies recommend social distancing and have, in many areas, prohibited group activities. Howell AYFC are taking steps to reduce the spread of COVID-19, however, Howell AYFC cannot guarantee that you or your children will not become infected with COVID-19. Further, attending Howell AYFC activities could increase your 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 and I my be exposed to or infected by COVID-19 attending Howell AYFC 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 COVID-19 may result in the act, omission, or negligence of myself and others. Including, but not limited to, Howell AYFC volunteers, other participants, and their families. I voluntarily agree to assume the foregoing risks and accept sole responsibility for any injury to my children 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 children may incur by reason if Howell AYFC. On my behalf, and on the behalf of my children, I hear by release and covenant not to sue Howell AYFC, its affiliated organizations, employees, volunteers,agents, and representatives, of and from the claims. * *

I Accept

By Typing / Signing Your Athletes Name and date below, You Agree To Your Duty To Inform :And all The Info on This Form Is True And Accurate, To The Best Of My Knowledge. * *

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