Please note that all students wishing to practice with us indoors will be asked to sign a form acknowledging the following requirements:
DECLARATION OF COMPLIANCE – COVID-19
Individual Name (print): ______________________________
Individual’s Parent/Guardian ______________________________
(if the individual is younger than 18 years old)
Email: ________________________________________
Phone: ________________________________________
WARNING!
ALL INDIVIDUALS PARTICIPATING IN SANCTIONED ACTIVITIES MUST COMPLY WITH THIS DECLARATION
The Canadian Aikido Federation and its organizational members and dojos (collectively the “Organization”) require the disclosure of exposure or illness in order to safeguard the health and safety of all participants and limit the further spread of COVID-19. This Declaration of Compliance will be kept safely, and personal information will not be disclosed unless as required by law or with your consent.
An individual (or the individual’s parent/guardian, if the individual is younger than 18 years old) who is unable to agree to the terms outlined in this document is not permitted to enter the Organization’s premises or participate in the Organization’s activities, programming, or services.
I, the undersigned being the individual named above and the individual’s parent/guardian (if the individual is younger than 18 years old), hereby acknowledge and agree to the terms outlined in this document:
- The coronavirus disease COVID-19 has been declared a worldwide pandemic by the World Health Organization and COVID-19 is extremely contagious. The Organization has put in place preventative measures to reduce the spread of COVID-19 and requires all individuals (or their parent/guardian, when applicable) to adhere to the compliance standards described in this document.
- The individual has not been diagnosed with COVID-19. OR If the individual was diagnosed with COVID-19, the individual was cleared as noncontagious by provincial or local public health authorities.
- If the individual is a front-line worker (such as hospital staff, long term care staff, or other individual who interacts with individuals who have confirmed or suspected cases of COVID-19), the individual has worn proper and approved Personal Protective Equipment at all times whenever they interacted with an individual who has a confirmed or suspected case of COVID-19 in the last 14 days.
- If the individual is not a front-line worker, they have not been exposed to a person with a confirmed or suspected case of COVID-19 in the last 14 days.
- The individual is attending or participating voluntarily and understands the risks associated with COVID-19. The individual (or the individual’s parent/guardian, on behalf of the individual (when applicable)) agrees to assume those risks, including but not limited to exposure and being infected.
- The individual has not, nor has anyone in the individual’s household, experienced any signs or symptoms of COVID-19 in the last 14 days (including fever, new or worsening cough, fatigue, chills and body aches, respiratory illness, difficulty breathing, nausea, vomiting or diarrhea, pink eye, or loss of taste or smell).
- If the individual experiences, or if anyone in the individual’s household experiences, any signs or symptoms of COVID-19 after submitting this Declaration of Compliance, the individual will immediately isolate, notify the Organization, and not attend any of the Organization’s activities, programming or services until at least 14 days have passed since those symptoms were last experienced.
- The individual is following recommended guidelines, including but not limited to, practicing physical distancing, trying to maintain separation of six feet from others, adhering to recognized hygiene best practices, and otherwise limiting exposure to COVID-19.
- The individual will follow the safety, physical distancing and hygiene protocols of the Organization.
- This document will remain in effect until the Organization, per the direction of the provincial government and provincial health officials, determines that the acknowledgements in this Declaration of Compliance are no longer required.
- The Organization may remove the individual from participation in the activities, programming or services of the Organization at any time and for any reason if the Organization believes, in its sole discretion, that the individual is no longer in compliance with any of the standards described in this document.
Signature: _______________________ Date: ___________________
Individual (if the individual is 18 years old or older)
Signature: _______________________ Date: ___________________
Parent/Guardian (if the individual is younger than 18 years old)