Meet Information

Print, sign and bring with you to the meet: 


The
coronavirus that causes Covid-19 is thought to spread largely through
respiratory droplets from coughing and sneezing, and it seems to spread easily.
It may also be possible to become infected by touching a contaminated surface
or object and then touching one's nose or mouth.

 

The
Vault House and Rocket Man Pole Vault, LLC, in accordance The Centers for
Disease Control and Prevention require that you initial each statement to
verify your agreement and adherence:

 

    I am symptom-free and
medically/physically fit to participate.

    No coughing

    No sneezing

    No symptoms of lower
respiratory illness (ie: shortness of breath)

    Notemperature above 100.4 F

    No other NEW symptoms listed
below which may be associated with COVID-19

    Fatigue

    Muscle aches and pain

    Loss of smell or taste

    Loss of appetite

    Diarrhea or nausea

    Sore Throat

    Runny Nose

    In the past 2 weeks, I have
NOT (or anyone in my household) traveled internationally or domestically

    In the past 2 weeks, I have
NOT been in close contact with someone under investigation for, or with a
confirmed case of Coronavirus Disease 2019 (COVID-19)?

    In the past 2 weeks, I have
NOT (or someone in my household) been diagnosed, tested or quarantined under a
doctor's orders for COVID-19? Check all that apply

    A doctor ordered me to
quarantine for possible COVID-19

    I was tested and am waiting
for my results

    I tested positive

    I tested positive for
antibodies (date:)

    Someone at home has fever,
cough or difficulty breathing but has not been diagnosed

    A doctor ordered someone in
my home to quarantine for possible COVID-19

    Someone in my home tested
positive

    None of the above

    I will shield any incidental
coughs and sneezes with a tissue, elbow, or shoulder (not the bare hands).

    I will take frequent breaks
to wash handswith soap and water for
at least 20 seconds

    I will not shake hands in
order to reduce the risk of spreading infection

    I understand that even in the
absence of symptoms, others in attendance could be infectious carriers of
Covid-19 and I assume the risk of contracting the virus.

    I agree that this waiver,
along with my previously submitted Participation Waiver, Release and Consent
Form, is binding.

    I agree to waive liability and
assume all risks of participation, and jointly and severally release, covenant
not to sue, and agree to fully indemnify and hold harmless The Vault House,
Rocket Man Pole Vault, LLC; Carpentier Properties, LLC; their respective
instructors/coaches, administrators, employees, agents, contractors, guests,
and business invitees, and all other participants, parents or
instructors/coaches in the Activity with Participant, Coach and Parent, from
all claims, loss or liability the Participant, Coach, or Parent may have
arising out of the medical treatment (including but not limited to authorization,
but not obligation to, The Vault House, Rocket Man Pole Vault, LLC; Carpentier
Properties, LLC and to their respective authorized agents to consent to
emergency medical treatment of Participant. Neither Rocket Man Pole Vault, LLC;
Carpentier Properties, LLC; Velocity Track Systems, LLC shall be under any
obligation to pay the cost of such treatment) and including of reasonable
attorney fees and costs of defense (as well as the costs of enforcing the
indemnity provisions of this Release) regardless of whether they are known or
unknown and regardless of when they arise, whether before or after the signing
of this Release.

 

__________________________________________________________________________________________Date___________

Participant (Please Print)Participant (Signature)

 

__________________________________________________________________________________________Date____________

Parent/Legal
Guardian (Please Print)Parent/Legal Guardian (Signature)

if participant is under the
age of 18

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