Covid-19 Indoor Playground Risk Assessment and Liability Waiver Form

Covid-19 Indoor Playground Risk Assessment and Liability Waiver Form
During this time where COVID-19 is prevalent, your health and safety are of our utmost importance. Although we might not be able to provide absolute safety amongst our staff, employees, especially our stakeholders, we assure you that safety precautions and strict compliance to the maintenance of personal hygiene are in place in order to protect everyone's health and to mitigate the risk of infection.
In this regard, please fill out and submit this Participant Risk Assessment and Liability Waiver Form in order to further proceed with the use of the playground.
Risk Assessment
Symptoms: I acknowledge that:
My child has not had any fever or temperature above 98.6 degrees fahrenheit within the past 14 daysMy child does not have any coldsMy child does not have a cough or is not experiencing shortness of breathMy child does not have flu or any of its symptoms
Environment and Travel: I acknowledge that:
My child did not travel outside the country nor has been in a city or any place that has high risk of COVID-19 in the past 14 daysMy child has not had any contact with a confirmed case of COVID-19 in the past 14 daysMy child does not have a cough or is not experiencing shortness of breathMy child does not have flu or any of its symptoms
Acknowledgement
I understand at any time that my child displays any symptoms relating to COVID-19, I will or an authorized representative shall pick up my child.I understand that during the time that my child has shown symptoms of COVID-19, he or she will not be able to go back to the playground until 14 days and until being cleared from any suspected sicknessI understand my responsibility to notify the playground daily during the quarantine period regarding the status of my child
Waiver
I, and on behalf of my minor child, hereby agree to release and discharge the playground, its agents, officers, stakeholders, employees, and volunteers, from any and all claims, demands, damages, injuries, or causes of action by which I may contract during my visit or in any case my child would acquire during his or her participation in any of the activities of the playground, or the use of any of its facilities.
I understand my responsibility in allowing my child to engage or participate in the activities of the playground, or make use of or access its facilities with underlying risks which could result in illnesses that may not be due to any fault by the playground.
I hereby indemnify and hold harmless the playground, its administrators, employees, volunteers, officers, or agents from any loss, liability, damage, or any cost that might be incurred during my child's participation.
By signing this form, I acknowledge that I have had the opportunity to understand the entire content. Any concerns, as well as those which were unclear to me, were explained to me properly and to my satisfaction. I understand that this is a legally binding agreement and that my signing of this document is of my free act and deed.
Name of Child
First NameLast Name
Name of Parent/Guardian
First NameLast Name
Email
example@example.com
Signature*
Clear
Should be Empty: