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PHASE 1 reopening Covid-19 - YOU MUST attest to the following / resign this waiver every time you skate/support/attend a Rose City Rollers event in the Hangar, on Oaks Park Property, or use our Skatemobile gear.

Do you have any of the following symptoms of COVID 19: 

 

·                    A fever of 100.4 degrees Fahrenheit or higher 

·                    A cough 

·                    Shortness of breath or difficulty breathing 

·                    New loss of Taste or Smell 

·                    Chills  

·                    Diarrhea 

·                    Sore Throat 

·                    Vomiting 

 NO

I Agree

 

Have you been asked by a Doctor or Public Health Official to Self-Quarantine anytime in the past 14 days? 

NO

I Agree
 

 

Have you been exposed anytime in the past 14 days to people exhibiting the above COVID-19 symptoms, including visiting or working at a facility with confirmed cases? 

NO

I Agree
 

IF YES to any of the above, you MUST NOT participate until you are able to confidently attest NO to the above.

 

I understand that up to 40 people a day are using the Hangar at Oaks Amusement Park as a workout space during Phase One, per the guidelines for gyms and workout facilities, and the space is being cleaned according to the posted directions, voluntarily and to varying degrees, by membership. 

I understand that, should I participate in ANY Rose City Rollers community activity, roller skating or otherwise, I MUST wear a mask when asked.

I understand that I need to be in compliance with "house rules" for each event: no outside alcohol, firearms, or symbols of hate will be permitted at Rose City Rollers events.

I acknowledge my voluntary exposure to the associated risks of participating in voluntary activities at this time.  

 

 


First Participants Name
First Name*
Middle Name
Last Name*
Phone*
First Participants Date of Birth*
Date of Birth
First Participants Signature*
Second Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Third Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Fourth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Fifth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Sixth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Seventh Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Eighth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Ninth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Tenth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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