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This assessment and waiver is required for participation in REEF events during the COVID-19 pandemic.

In order to help prevent the spread of COVID-19 and promote the well-being of all participants, everyone is required to complete this personal health status/medical history survey prior to participating in an in-person REEF event or prior to boarding a vessel as part of REEF activities. 

REEF event participants are required to consent to an infrared thermometer temperature check prior to participating in an in-person REEF event or prior to boarding a vessel as part of REEF activities. If you do not consent to the temperature check, or present with a temperature of 100+ degrees F or more, you will not be able to participate and/or board the vessel and you will not be eligible for a refund of any fees paid.

Participants of in-person programs will be required to wear a face mask at all times while indoors and while outdoors when social distances cannot be maintained. Participants boarding a vessel will be required to wear a face mask at all times while boarding and onboard the vessel, except when in the water. Personal, sanitized bins or bags will be provided to each participant. Face masks will be placed in the bin/bag immediately prior to entering the water, and retrieved immediately upon exiting the water.

If you are you aware of being in close contact (within 6 feet) with someone who has tested positive for COVID-19 in the past 14 days, REEF requests that you do not participate in the activity. If you have tested positive for COVID-19 in the last 14 days, you are not permitted to participate in REEF events. 

By signing this form, you confirm that you have read the conditions and policies and have answered the health screening question to the best of your ability.

I understand the need for this information, will answer the questions to the best of my ability, and will upate REEF if any of these conditions change prior to my participation in the REEF in-person event.

April 18, 2021

First Participant's Name

First Name*

Last Name*
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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Event Details

What event are you participating in that requires this waiver? *

What is the start date of the event that requires this waiver? *
Health Assessment
Have you currently or within the past 14 days exhibited any of the following COVID-19 symptoms that is new or unexplained in accordance with the Centers for Disease Control (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html)? These include: Fever (temperature of 100+ degrees) -- Cough -- Shortness of breath or difficulty breathing -- Fatigue -- Chills or repeated shaking -- Muscle or body aches -- Nausea or vomiting -- Headache -- Congestion or runny nose -- Sore throat -- Loss of taste and smell -- Diarrhea. If yes, you are not permitted to participate in the REEF activity and you are advised to contact your physician for assessment*
No
Yes
I agree to inform REEF I experience any of the symptoms outlined in the previous question during the program or within 14 days before the program.*
Yes
No
I understand that if I do exhibit symptoms during the REEF activity or within 14 days prior to the program start, I will not be able to participate / continue to participate in the REEF activity and I am not eligible for any refunds or credits.*
Yes
No
I understand that REEF event participants will have an infrared thermometer temperature check prior to participating in an in-person REEF event or prior to boarding a vessel as part of REEF activities. If I do not consent to the temperature check, or present with a temperature of 100+ degrees F or more, I understand that I will not be able to participate and/or board the vessel and will not be eligible for a refund of any fees paid. I also understand that during the REEF event I will be required to wear a face mask at all times while indoors and while outdoors when social distances cannot be maintained.*
Yes
No
Pre-existing Conditions
Please note that the following pre-existing conditions are risk factors that may increase the severity of COVID-19 symptoms: • Older adults-People 65 years and older • People who live in a nursing home or long-term care facility • People of any age who have serious underlying medical conditions, especially if their medical condition is not well controlled, including:  Chronic Lung Disease  Moderate to Severe Asthma  Heart Conditions  Compromised Immune System  Severe Obesity-Body Mass Index (BMI) ≥40  Diabetes  Chronic Kidney Disease or Individuals Undergoing Dialysis  Liver Disease Anyone meeting one or more of the above pre-existing conditions is encouraged to discuss risks with their health professional prior to participation. *
I have read and understand these risks.
COVID-19 Vaccination Status
Have you received the COVID-19 vaccine? *
Yes, I am fully vaccinated.
Yes, I have received the first dose of a two-dose vaccine and will receive my second dose as scheduled.
I am not yet vaccinated but I intend to receive the vaccine either through an already scheduled appointment or when I am eligible and the vaccine becomes available.
No, I am not vaccinated.
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*
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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