Cada jugador requiere llenar este waiver antes de cada partido
Return to Play Plan –Chester Summer Soccer League – COVID-19
Each player must complete and submit a waiver before EACH match. Players without a waiver will NOT be allowed to participate. NO EXCEPTIONS!
Player’s full name
Team name: _______________________________________________
ALL ANSWERS ARE ASSUMED TO BE “NO” IF THE WAIVER IS SIGNED UNLESS OTHERWISE NOTED BY THE PLAYER – any player who must report “yes” should print and return the waiver.
Does the player live in the same household or have close contact with someone who in the last 14 days has been in isolation for COVID-19 or had a test confirming the virus. Yes No
Has the player or anyone in the family (household) been in contact with someone who has tested positive for COVID-19 in the last 14 days? Yes No
Has the player exhibited any of the following symptoms today (or within the last 24 hour) which cannot be better explained by another condition?
Fever Yes No
Difficulty Breathing Yes No
Chills Yes No
Unusually Weak/Fatigued Yes No
Repeated Shaking/Shivering Yes No
Loss of Taste or Smell Yes No
Cough Yes No
Muscle Aches or Pain Yes No
Sore Throat Yes No
Runny/Congested Nose Yes No
Shortness of Breath Yes No
Diarrhea Yes No
Please provide additional information if symptoms present are better explained by another condition (e.g. exercise induced muscle soreness, diagnosed seasonal allergies).
If the player is experiencing any of the above symptoms prior to practice, without an explanation not related to possible COVID-19, the player is required to STAY HOME from game until symptom free.
I certify to the best of my knowledge; this information is accurate.
Chester Soccer League waiver / RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19 In consideration of being allowed to participate in the Chester Summer Soccer League the undersigned acknowledges, appreciates, certifies and agrees that:
- My 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, injury, and death does exist.
- If I have a pre-existing health condition, exposure to COVID-19, or any other infectious disease may be more likely to cause serious illness, injury, or death;
- The league cannot ensure that all other participants, including coaches and volunteers, are taking precautionary measures to mitigate risks to ensure the health and safety of other participants, coaches, and volunteers, and therefore, participation in match involves risk of exposure to infectious disease; 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 certify that I have not recently tested positive for, and am not exhibiting symptoms of COVID-19, which include a cough, shortness of breath or difficulty breathing, loss of taste or smell, headache, chills, muscle or body aches and/or sore throat.
- I certify that I do not have a household family member/roommate who has recently tested positive for or exhibited the above-referenced symptoms of COVID-19.
- I willingly agree to comply with all recommendations provided by the league to ensure safe play. If, however, I observe 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 coach, staff member or volunteer, or official immediately; and,
- I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Chester Summer Soccer League, and their partners, officers, officials, agents, and/or employees, other participants, volunteers, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the league, WITH RESPECT TO ANY AND ALL ILLNESS, INJURY, 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.
Name of participant: ___________________________ Date signed: ____________________