Please read and complete the form below to arrange an evaluation.
Please read and complete the form below to arrange an evaluation.
DECLARATION OF COMPLIANCE – COVID-19 STAGE 3
ALL INDIVIDUALS ENTERING THE FACILITY AND/OR PARTICIPATING IN SANCTIONED ACTIVITIES MUST COMPLY WITH THIS DECLARATION
Ontario Soccer and its affiliated districts, leagues, clubs and teams (collectively the “Organization”) require the disclosure of exposure or illness is 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 facilities or participate in the Organization’s activities, programs, 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 non contagious 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, or other individual who interacts with individuals who have confirmed or suspected cases of COVID-19, 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 withCOVID-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 facilities, activities, programs or services until at least 14 days have passed since those symptoms were last experienced.
- The individual is not currently under quarantine or required to isolate, as per a directive from the federal, provincial, or local government, or because of any other reason.
- 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.
- The individual will bring their own personal items and personal equipment (such as water bottles, bags, towels, etc.) at their discretion and will not share their personal items or equipment with other individuals.
- 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 the facility or from participation in the activities, programs 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.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
(To be signed by Participants of the age of majority and over- OVER 18)
WARNING! By signing this document, you will waive certain legal rights.
Please read carefully.
- This is a binding legal agreement. Clarify any questions or concerns before signing. As a Participant in activities,programs, classes, services provided and events sponsored or organized by Ontario Soccer and its affiliated districts, leagues, academy, clubs and teams and the sport of soccer, including but not limited to: games,tournaments, practices, training, personal training, dry land training, use of strength training and fitness conditioning equipment, machines and facilities, nutritional and dietary programs, orientational or instructional sessions or lessons, aerobic and anaerobic conditioning programs (collectively the “Activities”), the undersigned acknowledges and agrees to the following terms outlined in this agreement:
- Ontario Soccer, its affiliated districts, leagues, clubs and teams, and their respective directors, officers, committee members, members, employees, coaches, volunteers, officials, participants, agents, independent contractors,subcontractors, sponsors, owners/operators of the facility in which the Activities take place, , successors and assigns, and representatives (the “Organization”) are not responsible for any injury, property damage, expense,loss of income, damage or loss of any kind suffered by a Participant during, or as a result of, the Activities, caused in any manner whatsoever including, but not limited to, the negligence of the Organization.
Description of Risks
- I understand and acknowledge that
a) The Activities have foreseeable and unforeseeable inherent risks, hazards and dangers that no amount of care, caution or expertise can eliminate, including without limitation, the potential for serious bodily injury,permanent disability, paralysis and loss of life;
b) The Organization may offer or promote online programming (such as webinars, remote conferences,workshops, and online training) which have different foreseeable and unforeseeable risks than in-person programming;
c) The Organization has a difficult task to ensure safety and it is not infallible. The Organization may be unaware of my fitness or abilities, may misjudge weather or environmental conditions, may give incomplete warnings or instructions, and the equipment being used might malfunction; and
d) The novel coronavirus, 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; however, the Organization cannot guarantee that the Participant will not become infected with COVID-19. Further, attending the Activities could increase your risk of contracting COVID-19.
- I am participating voluntarily in the Activities. In consideration of my participation, I hereby acknowledge that I am aware of the risks, dangers and hazards associated with or related to the Activities which could result in damage, loss, serious physical injury, or death. The risks, dangers and hazards include, but are not limited to, injuries from:
a) Health: executing strenuous and demanding physical techniques, physical exertion, overexertion, stretching, dehydration, fatigue, cardiovascular workouts, rapid movements and stops, lack of fitness or conditioning, traumatic injury, bacterial infections, rashes, and the transmission of communicable diseases, including viruses of all kinds, COVID-19, bacteria, parasites or other organisms or any mutation thereof.
b) Premises: defective, dangerous or unsafe condition of the facilities; falls; collisions with objects, walls, equipment or persons; dangerous, unsafe, or irregular conditions on grass, turf or other surfaces, extreme weather conditions; travel to and from premises
c) Use of Equipment: mechanical failure of the equipment; negligent design or manufacture of the equipment; the provision of or the failure by the Organization to provide any warnings, directions, instructions or guidance as to the use of the equipment; failure to use or operate the equipment within my own ability.
d) Contact: contact with soccer balls, other equipment, poles, stands, soccer equipment, nets, fences, or other persons, whether intentional or unintentional, is a common part of soccer programs, and may lead to serious bodily injury, including but not limited to concussions and/or other brain injury, or serious spinal injury.
e) Advice: negligent advice regarding soccer programs
f) Ability: Failing to act safely or within my own ability or within designated areas
g) Sport: the game of soccer and its inherent risks
h) Conduct: My conduct and conduct of other persons including any physical altercation between soccer participants
i) Travel: Travel to and from the Activities
j) Negligence: My negligence and negligence of other persons, including NEGLIGENCE ON the PART OF THE ORGANIZATION, may increase the risk of damage, loss, personal injury or death. I understand that the Organization may fail to safeguard or protect me from the risks, dangers and hazards of soccer programs, some of which are referred to above.
- In consideration of the Organization allowing me to participate in the Activities, I agree:a) That my mental and physical condition is appropriate to participate in the Activities and I assume all risks related to my mental or physical condition;b) That when I practice or train in my own space, I am responsible for my surroundings and the location and equipment that I select;c) To comply with the rules and regulations for participation in the Activities;d) To comply with the rules of the facility or equipment;e) That if I observe an unusual significant hazard or risk, I will remove myself from participation and bring such to the attention of a The Organization representative immediately;
f) The risks associated with the Activities are increased when I am impaired, and I agree not to participate if impaired in any way;
g) That it is my sole responsibility to assess whether any Activities are too difficult for me. By commencing an Activity, I acknowledge and accept the suitability and conditions of the Activity;
h) That I am responsible for my choice of protective equipment and the secure fitting of that equipment; and
i) That COVID-19 is contagious in nature and I may be exposed to or infected by COVID-19 and such exposure may result in personal injury, illness, permanent disability or death and voluntarily agree to assume all the foregoing risks.
Release of Liability and Disclaimer
- In consideration of the Organization allowing me to participate in the Activities, use its equipment and facilities, I agree:
a) That the sole responsibility for my safety remains with me;
b) To ASSUME all risks arising out of, associated with or related to my participation;
c) That I am not relying on any oral or written statements made by the Organization or its agents, whether in a brochure or advertisement or in individual conversations, to agree to be involved in the Activities;
d) To WAIVE any and all claims that I may have now or in the future against the Organization;
e) To freely ACCEPT AND FULLY ASSUME all such risks and possibility of personal injury, death, property damage, expense and related loss, including loss of income, resulting from my participation in the activities, events and programs of the Organization;
f) To FOREVER RELEASE AND INDEMNIFY the Organization from any and all liability for any and all claims, demands, actions, damages (including direct, indirect, special and/or consequential), losses, actions, judgments, and costs (including legal fees) (collectively, the “Claims”) which I have or may have in the future, that might arise out of, result from, or relate to my participation in the Activities, even though such Claims may have been caused by any manner whatsoever, including but not limited to, the negligence, gross negligence, negligent rescue, omissions, carelessness, breach of warranty, breach of contract and/or breach of any statutory duty of care of the Organization;
g) TO HOLD HARMLESS AND INDEMNIFY the Organization from any and all liability for any damage, loss, expense or injury to any third party resulting from my participation in the Activities.
h) To FOREVER RELEASE AND INDEMNIFY the Organization relating to becoming exposed to or infected by COVID-19 which may result from the actions, omission or negligence of myself and others, including but not limited to the Organization;
i) That the Organization is not responsible or liable for any damage to my vehicle, property, or equipment that may occur as a result of the Activities;
j) That negligence includes failure on the part of the Organization to take reasonable steps to safeguard or protect me from the risks, dangers and hazards associated with the Activities; and
k) This release, waiver and indemnity is intended to be as broad and inclusive as is permitted by law of the Province of Ontario and if any portion thereof is held invalid, the balance shall, notwithstanding, continue in full legal force and effect.
- I agree that in the event that I file a lawsuit against the Organization, I agree to do so solely in the province of Ontario, Canada and further agree that the substantive law of Ontario will apply without regard to conflict of law rules. I further agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.
CONSENT FOR MEDICAL TREATMENT
In the event that my child is injured or ill, I hereby give consent to medical personnel to administer medical treatment to my child including medical and surgical services including x-ray, anesthesia and drugs as deemed necessary for the safety and welfare of my child. I authorize the information on this form to be released to all medical personnel and any other necessary parties. I understand that it is my responsibility to advise the coaching staff and management immediately if there is any change to the above information
CONSENT FOR USE OF PERSONAL INFORMATION
I, the Participant and/or the Parent/Guardian of the Participant
1. Authorize the Blue Devils Academy, the Canadian Soccer Association, the Ontario Soccer Association and District Leagues, (collectively the “Organizations”) to collect and use personal information about the Participant for the purpose of receiving communications and the purposes described in the Organizations respective Privacy Policies.
2. Grant permission to the Organizations and anyone authorized by them, permission to use the Participant’s name, likeness, image, voice, appearance and/or performance whether recorded on or transferred to videotape, film, slides, photographs, audio tapes, digital media, or other media, now known or later developed.
3. Authorize the inclusion of the Participant in photographs and video and understand that this media will be used on the Blue Devils Academy’s website, social media, hosted photo galleries and other sites related sites. Photos and videos may also be taken at any time for print or online promotional purposes but participants will not be identified.
4. Understand that such consent may be withdrawn at any time by sending an email to firstname.lastname@example.org
- I acknowledge that I have read and understand this agreement, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, spouse, children, parents, guardians, next of kin, executors, administrators and legal or personal representatives. I further acknowledge by signing this agreement I have waived my right to maintain a lawsuit against the Organization on the basis of any claims from which I have released herein.
- I acknowledge that I have read this agreement and understand it, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, spouse, children, parents, guardians, next of kin, executors, administrators and legal or personal representatives.
Recognizing the possibility of physical injury associated with soccer and in consideration for the individual organization accepting the registrant for its programs and activities, I hereby release, discharge, and/or indemnify the Blue Devils Academy, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.
As the Parent of Legal Guardian of the above named player or Player over 18, I hereby give consent for emergency medical care provided by an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.
I understand that any personal information collected on Blue Devils Academy forms is collected and intended to be used to enable the Blue Devils Academy to deliver its programs to its members. My personal information will be kept secure and will not be shared with anyone other than those individuals charged with administering the Blue Devils Academy programs or in cases where disclosure is required to participate in a sanctioned event.
I give my full permission to the Blue Devils Academy to use my (and that of the registrant) name, likeness, photographs, videotapes or other recordings of me (and the registrant) that are made during my participation in Blue Devils Academy events, for promotional purposes. (You may request an exclusion by sending an email to email@example.com quoting the player name and reason for exclusion.)