Questionnaire and waiver

COVID-19 Pre-Participation Health Questionnaire

Have you had any of the following symptoms in the previous 2 weeks?


I acknowledge the contagious nature of the Corona Virus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.

I further acknowledge that Rolesville Lightning Track Club has put in place preventative measures to reduce the spread of the Corona Virus/COVID-19.

I further acknowledge that Rolesville Lightning Track Club cannot guarantee that I will not become infected with the Corona Virus/Covid-19. I understand that there is still a risk of becoming exposed to and/or infected by the Corona Virus/COVID-19.

I voluntarily seek the services provided by Rolesville Lightning Track Club and acknowledge that I am increasing my exposure risk to the Corona Virus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending practices and meets.

I attest that:
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Corona Virus/COVID-19.
* I have not been diagnosed with Corona Virus/Covid-19 and not yet cleared as non- contagious by state or local public health authorities.
* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Corona Virus/COVID-19.

I hereby release and agree to hold Rolesville Lightning Track Club harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by Corona Virus/COVID-19 or that may otherwise arise in any way in connection with any services received from Rolesville Lightning Track Club. I understand that this release discharges Rolesville Lightning Track Club from any liability or claim that I, my heirs, or any personal representatives may have against them with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, Corona Virus/COVID-19. This liability waiver and release extends to the Rolesville Lightning Track Club together with all owners, partners, and workers.

By entering the Guardian and Athlete's name below I state that to the best of my knowledge, the answers to the above are complete and correct.

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