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Pre-Trip/ Course Declaration of Health and Exposure

Members of the ACMG take the safety of their guests and employees, and the prevention of the spread of the COVID-19 pandemic very seriously. As such, you are required to make four attestations below for yourself and/or your child. The inability to make one or more of these attestations may disqualify you and/or your child from participation.

I, the undersigned, attest to the following: In the case of a minor, “I” refers to that minor.

I Agree

To the best of my knowledge, I do not have the novel coronavirus COVID-19 or any variant of the novel coronavirus COVID-19, nor have I had it within the past 14 days

I Agree

To the best of my knowledge, I have not been exposed to someone who has the novel coronavirus COVID-19 or any variant of the novel coronavirus COVID-19 within the past 14 days

I Agree

Within the past 14 days, I have not experienced any of the following that are new and not related to allergies or pre-existing conditions: persistent cough, fever higher than 38 degrees Celsius (100.4 degrees Fahrenheit), shortness of breath, sore throat, flu-like symptoms, runny nose

I Agree

I have not travelled outside Canada during the past 14 days

I Agree

By signing below, I confirm my understanding that I and/or my child may be refused participation in, or be asked to leave, this trip/course, with no option for refund of payment, if any of the above attestations are found to be incorrect or if the status of those attestations changes between the time of signing of this form and any time before the end of the trip/course.

August 8, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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*

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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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