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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
 

 

Have you been in a group defined as a "gathering of MORE than 25 people WITHOUT physical distancing," within the past 14 days?

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 am required to keep a 6 foot distance from non household attendees, and MUST wear a mask per the govenors mandate.

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*
First Participants Signature*
Second Participants Name

First Name*

Middle Name

Last Name*
Second Participants Date of Birth*
Third Participants Name

First Name*

Middle Name

Last Name*
Third Participants Date of Birth*
Fourth Participants Name

First Name*

Middle Name

Last Name*
Fourth Participants Date of Birth*
Fifth Participants Name

First Name*

Middle Name

Last Name*
Fifth Participants Date of Birth*
Sixth Participants Name

First Name*

Middle Name

Last Name*
Sixth Participants Date of Birth*
Seventh Participants Name

First Name*

Middle Name

Last Name*
Seventh Participants Date of Birth*
Eighth Participants Name

First Name*

Middle Name

Last Name*
Eighth Participants Date of Birth*
Ninth Participants Name

First Name*

Middle Name

Last Name*
Ninth Participants Date of Birth*
Tenth Participants Name

First Name*

Middle Name

Last Name*
Tenth Participants 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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's 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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