Waiver 2020 - Victoria Local Swim, Bike and Run Training Sessions
1.
Please provide your contact information:

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:
Country:

2.
Gender:
Male
Female
3.
Month of Birth:
January
February
March
April
May
June
July
August
September
October
November
December
4.
Day of Birth:
 

50 characters left.
5.

Year of Birth:

 

50 characters left.
6.
PARTICIPANT AGREEMENT AND WAIVER
 
For my participation in swimming, running, biking, endurance, multi-sport, strength, or any other training sessions, I certify that I am physically fit and sufficiently trained for participation in these services and that I have not been advised against participation by a qualified health professional. In consideration of this agreement, I hereby indemnify, release and forever discharge Pinnacle Fitness Inc., Mercury Rising Triathlon, and their coaches, from any liability, claims, losses, costs, or expenses, and waive the right to pursue legal action arising directly or indirectly from my participation in the services, including claims or damages resulting from death, personal injury, partial or permanent disability or property damage, medical or economic losses. This agreement shall be binding upon my heirs, assignees, successors and personal representatives. I hereby further state that I currently suffer from no physical or mental condition that would impair my ability to fully participate in this agreement. I represent and warrant that I am eighteen (18) years of age or older and, if not, I have the permission of a parent or guardian to participate in these activities who has reviewed and agreed to the terms and conditions in this waiver. 

I hereby agree to terms and conditions listed above;
Yes
No
7.
COVID-19

I do not have COVID-19 or any of symptoms of COVID-19. If I develop any symptoms of COVID-19, I agree that I will not attend this training session.
 
I agree to provide my contact details in order to be contacted in the case of COVID-19 to assist with the contact tracing of the virus.
 
I agree that if I contract COVID-19 as a result of this training session, I am not entitled to any compensation and release the organizers and volunteers of any liability.
 
I agree to follow the COVID-19 GUIDANCE FOR ORGANIZED OUTDOOR SPORT - Guiding Principles terms and conditions.

I agree to follow the COVID-19 GUIDANCE FOR ORGANIZED OUTDOOR SPORT - COVID-19 Risk Mitigation Considerations for Organizations terms and conditions.
 
I agree to follow the COVID-19 GUIDANCE FOR ORGANIZED OUTDOOR SPORT - Training Session Specific Practices terms and conditions.

All terms and conditions for COVID-19 GUIDANCE FOR ORGANIZED OUTDOOR SPORT can be reviewed at www.pinnaclefitness.ca/local

I hereby agree to terms and conditions listed above;
Yes
No
8.
SCREENING CHECKLIST - COVID 19

I agree to review the COVID-19 Screening Checklist below before each and every training session. I confirm that my answers to all the questions in Screening Checklist are "NO". If any answers are "YES", I confirm that I will not attend the training session.

1. Does the person attending the activity, have any of the below symptoms:
  • Fever
  • Cough
  • Shortness of Breath / Difficulty Breathing
  • Sore throat
  • Chills
  • Painful swallowing
  • Runny Nose / Nasal Congestion
  • Feeling unwell / Fatigued
  • Nausea / Vomiting / Diarrhea
  • Unexplained loss of appetite
  • Loss of sense of taste or smell
  • Muscle/ Joint aches
  • Headache
  • Conjunctivitis
 
2. Have you, or anyone in your household, travelled outside of Canada in the last 14 days?

3. Have you or your children attending the program had close unprotected* contact (face-to-face contact within 2 metres/6 feet) with someone who is ill with cough and/or fever?
 
4. Have you or anyone in your household been in close unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19?


I will review this screening checklist before each and every workout and if any of the above answers are "YES", I will not attend the training session.


I hereby agree to the terms and conditions listed above;

Yes
No