COVID-19 Screening, Assumption of Risk, and Waiver of Liability Form - Adult Athlete


Given the COVID-19 environment, The Fortis Academy is requiring all athletes to adhere to the following safety guidelines and provide the below information in order to reduce the risk or spread of infection.

Please initial next to each statement.

  I have not had contact with anyone confirmed with COVID-19 in the past 14 days. At any point in the future, if I have reason to believe I have come into contact with someone with COVID-19, I agree to immediately notify The Fortis Academy staff.

  I am not currently experiencing a fever over 100, difficulty breathing, sore throat, or cough. At any point in the future, if I have any of these symptoms, I will notify The Fortis Academy staff immediately. I agree to not participate in any training sessions with these symptoms, and wait at least seven days after symptoms have subsided to return to training or provide Fortis with a COVID-19 negative test.

 I have not had any of the following symptoms in the last 14 days: fever greater than 100 degrees, difficulty breathing, or cough.

If you have any of the following underlying health conditions or you live with someone with these conditions, you should continue a virtual training program:

Chronic heart disease
Chronic lunge disease
Chronic kidney disease
Moderate to severe asthma
Obesity Diabetes Reside with a family member with high risk underlying conditions
Other underlying conditions

I have read the information and answered the questions above to the best of my ability. I agree to continue to adhere to the above safety guidelines as long as I participate in Fortis Academy training.

Assumption of Risk and Waiver of Liability Relating to COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. However, there remain many unknowns about COVID-19, how it spreads, and its impact on athletes.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending Fortis Academy training sessions and activities and that such exposure or infection may result in severe illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Fortis may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Fortis employees, contractors, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at The Fortis Academy or participation in The Fortis Academy programming (“Claims”). On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless The Fortis Academy, 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 Fortis Academy, its employees, contractors, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Fortis Academy program.

 

Leave this empty:

Signature arrow


Signature Certificate
Document name: COVID-19 Screening, Assumption of Risk, and Waiver of Liability Form - Adult Athlete
lock iconUnique Document ID: 50a281bc53bbed7f5c3656f44699bfd07124da62
Timestamp Audit
May 3, 2020 2:48 pm EDTCOVID-19 Screening, Assumption of Risk, and Waiver of Liability Form - Adult Athlete Uploaded by Josh Levine - josh@thefortisacademy.com IP 66.147.244.172