Waiver 2021 - Pinnacle Fitness Training Sessions
RequiredRequired Question(s)
Required 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:

Required 2.
Gender:
Male
Female
Required 3.
Month of Birth:
1
2
3
4
5
6
7
8
9
10
11
12
Required 4.
Day of Birth:
 

50 characters left.
Required 5.

Year of Birth:
 

50 characters left.
Required 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., 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 the terms and conditions listed above;
Yes
No
Required 7.
PATICIPANT AGREEMENT AND WAIVER (cont'd)

As a Participant in these programs, I agree to abide by the following points when entering program/club facilities and/or participating in program/club activities:
  • I do not have COVID-19 or any of symptoms of COVID-19. 

  • I agree to stay home if feeling sick and remain home for 14 days if experiencing COVID-19 symptoms.

  • 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 symptom screening checks.
  • I agree to sanitize my hands upon entering and exiting the facility, with soap or sanitizer.
  • I agree to sanitize the equipment I use throughout my practice with approved cleaning products provided by the program/club/facility (shared and personal equipment).
  • I agree to continue to follow social distancing protocols of staying at least 2 meters away from others.
  • I agree to not share any equipment during practice times
  • I agree to abide by all of my program/club/facility's COVID-19 Policies and Guidelines
  • I understand that if I do not abide by the aforementioned policies/ guidelines, that I may be asked to leave the program/club/facility for up to 14 days to help protect myself and others around me.
  • I acknowledge that continued abuse of the policies and/or guidelines may result in temporary suspension of my program/club membership.
  • I acknowledge that there are risks associated with entering program facilities and/or participating in program/club activities, and the measures taken by the program/club and participants, including those set out above.

I hereby agree to the terms and conditions listed above;
Yes
No
Required 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. Do you, 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
Required 9.
OTHER AGREEMENTS

As a Participant in these programs, I have reviewed other agreements and documents that are required by third parties in order to attend this program.  Agreements and documents could include:

1. Facility Waivers (ie. Saanich Commonwealth Place Assumption of Risk Waiver)
2. Facility Guidelines (ie. Saanich Commonwealth Place Swimming Pool Guidelines)

I hereby agree;
Yes
No