ACSL Covid-19 waiver

WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT

In consideration of being allowed to participate on behalf of Albany Co-ed Soccer League

(ACSL) and related events and activities, the undersigned acknowledges, appreciates, and

agrees that:

☐Participation includes possible exposure to and illness from infectious diseases

including but not limited to MRSA, influenza, and COVID-19. While particular rules and

personal discipline may reduce this risk, the risk of serious illness and death does

exist; and,

☐I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown,

EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and

assume full responsibility for my participation; and,

☐I willingly agree to comply with the stated and customary terms and conditions for

participation as regards protection against infectious diseases. If, however, I observe

and any unusual or significant hazard during my presence or participation, I will remove

myself from participation and bring such to the attention of the nearest official

immediately; and,

☐I, for myself and on behalf of my heirs, assigns, personal representatives and next of

kin, HEREBY RELEASE AND HOLD HARMLESS Albany Co-ed Soccer League their

officers, officials, agents, and/or employees, other participants, sponsoring agencies,

sponsors, advertisers, and if applicable, owners and lessors of premises used to

conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS,

DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING

FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent

permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT,

FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP

SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY

WITHOUT ANY INDUCEMENT.

I acknowledge, agree and consent that:

In the past 14 days, I have not tested positive for or been diagnosed with COVID-19.

In the past 14 days, I have not been within 6 feet, for 10 minutes or longer, of someone who

has tested positive for or been diagnosed with COVID-19. (FOR HEALTHCARE WORKERS:

In the past 14 days, if I have had or may have had exposure to patients with COVID-19, I

have consistently used personal protective equipment and appropriate hand hygiene during

these patient contacts.)

In the past 3 days, I have not experienced the following or any other symptoms consistent

with the COVID-19 infection.

a. Fever or high temperature b. Loss or change to sense of taste c. Loss or change to sense

of smell d. Feeling unwell e. Loss of appetite (skipped meals) f. Increased tiredness or fatigue

g. Coughing or a new and continuous cough h. Nasal congestion or a sore throat i. Body

aches or chills j. Shortness of breath or chest tightness k. Diarrhea or abdominal pain l.

Headache

In the past 7 days, I have not tested positive for or been diagnosed with COVID-19.

In the past 7 days, I have not experienced the symptoms listed in clause 3 above or any other

symptoms consistent with the COVID-19 infection.

In the past 14 days, I have not been in contact with a person who has tested positive for

COVID-19, lived with or spent significant time in the same household as a person who has

tested positive for COVID-19, or had face-to-face contact (within 3 feet) with, or been within 6

feet for 15 minutes or longer of, a person who tested positive for COVID-19.

If I have recently traveled out of the state or country, I certify that I am in compliance with any

and all applicable government-mandated travel advisories requiring COVID-19 testing and/or

a mandatory self-quarantine period. Accordingly.

I have been fully vaccinated (e.g. 2 weeks after my second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine) and I voluntarily assume the risks of any and all potential injuries and illnesses associated with removing my face covering.

Electronic Signature and Acknowledgement

Enter the date and your full name to acknowledge your electronic signature of this document.

Date*

Your Full Name*

Team*

Your Electronic Signature*