User Self-Certification / Acknowledgment (”Schedule A”)

To be completed every time by the undersigned prior to participation in any activities or attendance at any University of Waterloo athletic facility.

Please read the below, complete where indicated and sign where indicated.

I, _______________________ attest to the following"

I understand the causes of the disease known as COVID-19 and that it is currently a pandemic. I understand COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be contagious. For this reason, it is recommended to stay home and avoid close contact with other people when at all possible.

I understand the federal and provincial governments have asked individuals to maintain social distancing of a least 2 metres (6 feet) and I recognize it may not be possible to maintain this distance while participating in activities at a University of Waterloo athletic facility.

I understand that due to the participation of other persons in such activities, and the characteristics of COVID-19, that I have an elevated risk of contracting COVID-19 simply by being at a University of Waterloo athletic facility.

I confirm that I have not tested positive for COVID-19.

At least 14 days have passed since my fever and/or respiratory symptoms ceased.

I have not travelled outside Canada within the last 14 days.

I have not, within the last 14 days, had close unprotected contact with a confirmed or probable case of COVID-19 or a person with acute respiratory illness who has been to a country/region where COVID-19 is present.

I confirm that this is not currently a period where I required to self-isolate for 14 days.

I verify the information I have provided on this form is truthful and accurate. I knowingly and willingly consent to attendance at a University of Waterloo athletic facility during the COVID-19 pandemic.

My attendance at a University of Waterloo maintained athletic facility is purely voluntary, and I freely accept and fully assume all such risks, dangers and hazards.

In consideration of the University of Waterloo allowing me to attend at a University of Waterloo maintained athletic facility, and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I hereby agree as follows:

1) To waive any and all claims that I have or may have in the future against the University of Waterloo and to release the University of Waterloo from any and all liability for any loss, damage, expense or injury, including death, that I may suffer or that my next of kin may suffer, as a result of COVID-19;

2) To hold harmless and indemnify the University of Waterloo from any and all liability for any damage, loss, claim, action, suit or personal injury resulting, directly or indirectly, from my attendance at a University of Waterloo maintained field, diamond or other athletic facility; and

3) I hereby consent to the collection, use, disclosure and/or transmittal by the University of Waterloo of the personal information set out herein for the purpose of proceedings related to COVID-19 including disclosure to any government agency, public health office, health organization and any affiliates, subsidiaries, subcontractors and agents of such institutions; and

4) I covenant and agree to follow and comply with all applicable laws, orders, regulations, ordinances and other rules of all lawful authorities acting within their power in respect of

This Acknowledgement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives.

By entering into this Acknowledgement I am not relying on any oral or written representations or statements made by the University of Waterloo with respect to the safety of my attendance at a University of Waterloo maintained athletic facility.

I confirm that I have read and understood this Acknowledgement prior to signing it, and I am aware that by signing this Acknowledgement I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators, assigns and representatives, may have against the University of Waterloo, and that I am signing this Acknowledgement voluntarily, realizing that it is a legally binding document.

This Acknowledgement shall continue indefinitely.