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Madison Circus Space COVID-19 Waiver

An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and, in some cases, death. By entering and attending Madison Circus Space, I voluntarily assume all risks related to exposure to COVID-19. I represent that I am in good health and have had no known exposure to COVID-19 and no symptoms of COVID-19, including fever, sudden loss of taste or smell, vomiting or diarrhea, cough, shortness or breath or sore throat, for 14 days prior to attending the facility. I acknowledge that if I believe I have had any exposure to COVID-19, I will immediately cease attendance at the facility until I can again warrant that I have had no known exposure for the 14-day period and alert the facility if I have been on the premises since my exposure. I hereby acknowledge and agree that I will adhere to the following safety and health protocols, whether as a member, student, or other participant at Madison Circus Space as follows: 

I will maintain a social distance of at least six (6) feet from others in Madison Circus Space including, but not limited to, interactions with coaches, other employees, guests, members, and other individuals I may come into contact with, unless in an emergency scenario or in sharing space with members of my family or household;
I will use any personal protective equipment (“PPE”) that is recommended by applicable public health and/or MCS’ guidelines for using the space;
I understand that by using MCS, I could contract COVID-19 and I, hereby, provide my informed consent, or if applicable, my guardian gives informed consent on my behalf, of such risk.

I Agree

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
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*

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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