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This waiver releases Brandon All-Stars Jacksonville of all liability associated with COVID-19.

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.  
I further acknowledge that Brandon All-Stars has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. 
I further acknowledge that Brandon All-Stars cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, BA staff, and other BA clients and their families. 
I voluntarily seek services provided by Brandon All-Stars and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. 
I attest that: 
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. 
* I have not traveled internationally within the last 14 days. 
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.  
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities. 
* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. 
I hereby release and agree to hold Brandon All-Stars harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of BA, or that may otherwise arise in any way in connection with any services received from Brandon All-Stars. I understand that this release discharges Brandon All-Stars from any liability or claim that I, my heirs, or any personal representatives may have against BA with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Brandon All-Stars. This liability waiver and release extends to BA together with all owners, partners, and employees. 

BA Jax Mandatory Rules and Regulations 

· Wear a mask while entering and exiting the facility 
· Mask must be worn while in lobby to receive temperature check and agree to not have taken any fever reducers prior to coming to practice 
· Hand sanitizer must be applied before entering the gym and during all class/team breaks

First Athlete’s Name

First Name*

Middle Name

Last Name*

Phone*
First Athlete’s Date of Birth*
First Athlete’s Signature*
Second Athlete’s Name

First Name*

Middle Name

Last Name*
Second Athlete’s Date of Birth*
Third Athlete’s Name

First Name*

Middle Name

Last Name*
Third Athlete’s Date of Birth*
Fourth Athlete’s Name

First Name*

Middle Name

Last Name*
Fourth Athlete’s Date of Birth*
Fifth Athlete’s Name

First Name*

Middle Name

Last Name*
Fifth Athlete’s Date of Birth*
Sixth Athlete’s Name

First Name*

Middle Name

Last Name*
Sixth Athlete’s Date of Birth*
Seventh Athlete’s Name

First Name*

Middle Name

Last Name*
Seventh Athlete’s Date of Birth*
Eighth Athlete’s Name

First Name*

Middle Name

Last Name*
Eighth Athlete’s Date of Birth*
Ninth Athlete’s Name

First Name*

Middle Name

Last Name*
Ninth Athlete’s Date of Birth*
Tenth Athlete’s Name

First Name*

Middle Name

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

Email*

Confirm Email*
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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*

Relationship*

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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