PARTICIPANT ACKNOWLEDGMENT


Novel Coronavirus (COVID-19)

To: All participants enrolled in activities (hereinafter referred to as the “Activities”) organized by the Worthington Swim Club and Swiminc. Inc., provided at the Worthington Pools Facilities and/or at other locations (hereinafter referred to as the “Facilities”) and his/her parent or guardian.

To ensure the safety and health of all participants, coaches, and staff, prior to proceeding into the Facilities, I, the undersigned parent or legal guardian of one (1) or more participants (each a “Participant”), attest to the following requirements:

  • I, each Participant, and all of our household members are not suspected** to have, COVID-19.
  • In the last two weeks, I, each Participant, and all of our household members have NOT been diagnosed with COVID-19.
  • In the last two weeks, I, each Participant, and all of our household members have NOT been in close contact* with someone who has been confirmed to have, or is suspected** to have, COVID-19.
  • In the last two weeks, I, each Participant, and all of our household members have NOT been under quarantine for COVID-19.
  • I, each Participant, and all of our household members are NOT currently experiencing symptoms consistent with COVID-19. Per the CDC, symptoms include fever, cough, and shortness of breath.
  • I, each Participant, and all of our household members ARE practicing good hygiene including the following:
    • Washing our hands frequently with soap and water for at least 20 seconds,
    • Avoiding touching our eyes, nose, and mouth with unwashed hands,
    • Staying home when sick,
    • Covering coughs and sneezes with a tissue, then disposing properly of the tissue.
  • I, each Participant, and all of our household members WILL practice Social Distancing, wear protective masks, and ensure a minimum of 6ft between me and all other persons.

If I am unable to attest to the above requirements, I understand that I am NOT permitted to enter the Facilities.

By signing below, I acknowledge that I have read and can attest to the above requirements.

Parent or Guardian:

 

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Worthington Pools https://worthingtonpools.com
Signature Certificate
Document name: PARTICIPANT ACKNOWLEDGMENT
lock iconUnique Document ID: 032f9737b47c985e7e74f9afe8a6b94b7599284e
Timestamp Audit
August 9, 2020 12:32 pm ESTPARTICIPANT ACKNOWLEDGMENT Uploaded by Chad Davis - office@worthingtonpools.com IP 74.140.3.215