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Acknowledgement of COVID-19 Risk Form


TOWN OF AVON
DEPARTMENT OF RECREATION & PARKS

Acknowledgement of COVID-19 Risk Form

The Town of Avon Department of Recreation & Parks must inform program participants, or in the case of a minor child, a parent or guardian, (herein referred to as “the Participant”) and users of Town facilities (herein referred to as “the User”) of the risk of exposure to COVID-19. The [choose one] Participant/User understands and makes the following acknowledgements as related to the COVID-19 pandemic and his/her participation in a Town of Avon Department of Recreation & Parks program (“the Program”)/use of a Town parks and recreation area, including but not limited to pavilions, buildings, restrooms, porto-potties, electrical panels, picnic tables, and other amenities (herein referred to as “the Facility”).

1. The Participant/User understands the risks associated of participating in the Program/using the Facility. The Participant/User understands that certain groups may be at higher risk of severe illness from COVID-19 such as individuals 65 years and older; individuals who live in a nursing home or a long term care facility, and; individuals with underlying medical conditions as defined by the Centers for Disease Control (CDC).

2. The Participant/User acknowledges that the Town of Avon cannot guarantee that the Program Location/Town Facility is a COVID-19 free area.

3. The Participant/User chooses to participate in the Program/Use the Facility at his/her/its own risk.

4. The Participant/User acknowledges that if he/she contracts COVID-19, he/she will not sue the Town of Avon and is assuming the risk. The Participant/User shall indemnify and hold the Town harmless from any and all claims, losses, damages, judgements, costs, settlements, fines, penalties, and expenses (including legal fees) that the Town may incur, directly or indirectly as a result of the Participant/User, a member of the User, or a third party contracting COVID-19.

5. Participant/User agrees to abide by all state and federal requirements as related to COVID-19 including, but not limited to public gathering limitations, social distancing, and use of personal protective equipment.

6. For Program Participants only: The Participant acknowledges that the Town of Avon and its instructors have implemented a number of protocols and procedures including mask wearing, disinfecting surfaces, observing staff and participants for illness, maintaining social distance of six feet, and frequent handwashing/sanitization. The Participant agrees to adhere to any and all health and safety protocols or procedures implemented by the Town of Avon in its sole discretion, at any point during the Program.

I hereby attest that I have been informed of, understand and agree to the above (sign below where applicable).

If Program Participant:
____________________________________                 _____________________
Signature of Participant, or if minor child,                       Date
Signature of Parent/Guardian  

OR

If Facility User is an Individual:

______________________________________             ______________________
Signature of Applicant                                                  Date

OR

If Facility User is an Organization:

______________________________________            ______________________
Type of Print Name of Organization                               Date

By: __________________________________

Its: __________________________________