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DECLARATION OF COMPLIANCE – COVID-19

WARNING!
ALL INDIVIDUALS MUST COMPLY WITH THIS DECLARATION


BC Wheelchair Sports Association and its member clubs (collectively the “Organization”) require the disclosure
of exposure or illness in order to safeguard the health and safety of all participants and limit the further
outbreak of COVID-19 and other contagious disease. This Declaration of Compliance will be kept safely and
personal information will not be disclosed unless as required by law or with your consent.


An individual (or the individual’s parent/guardian, if the individual is younger than the age of majority) who is
unable to agree to the terms outlined in this document is not permitted to enter the Organization’s facilities or
participate in the Organization’s activities, programs, or services.


I, the undersigned being the individual named above and the individual’s parent/guardian (if the individual is
younger than the age of majority), hereby acknowledge and agree to the terms outlined in this document:


1) The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health
Organization and COVID-19 is extremely contagious. The Organization has put in place preventative
measures to reduce the spread of COVID-19 and requires all individuals (or their parent/guardian, when
applicable) to adhere to the compliance standards described in this document.


2) The individual has not been diagnosed with COVID-19; OR If the individual was diagnosed with COVID-19,
the individual was cleared as noncontagious by provincial or local public health authorities more than 14
days prior to the date this Declaration of Compliance was signed.


3) The individual has not been exposed to a person with a confirmed or suspected case of COVID-19; OR If the
individual was exposed to a person with a confirmed case of COVID-19, the date of exposure was more
than 14 days prior to the date this Declaration of Compliance was signed.


4) The individual is attending or participating voluntarily and understands the risks associated with COVID-19.
The individual (or the individual’s parent/guardian, on behalf of the individual (when applicable)) agrees to
assume those risks, including but not limited to exposure and being infected.


5) The individual has not, nor has anyone in the individual’s household, experienced any signs or symptoms of
COVID-19 in the last 14 days (including fever, new or worsening cough, fatigue, chills and body aches,
respiratory illness, difficulty breathing, nausea, vomiting or diarrhea, pink eye, or loss of taste or smell).


6) If the individual experiences, or if anyone in the individual’s household experiences, any signs or symptoms
of COVID-19 after submitting this Declaration of Compliance, the individual will immediately isolate, notify
the Organization, and not attend any of the Organization’s facilities, activities, programs or services until at
least 14 days have passed since those symptoms were last experienced.


7) The individual has not, nor has any member of the individual’s household, travelled to or had a lay-over in
any country outside of Canada, or in any province/territory outside of their resident province/territory in
the past 14 days. If the individual travels, or if anyone in the individual’s household travels, outside of their
resident province/territory after submitting this Declaration of Compliance, the individual will not attend
any of the Organization’s facilities, activities, programs or services until at least 14 days have passed since
the date of return. These restrictions apply in accordance with provincial and federal guidelines.


8) The individual is following recommended guidelines and protocols of the Provincial Government including
but not limited to, practicing physical distancing, trying to maintain separation of six feet from others,
adhering to recognized hygiene best practices, and otherwise limiting exposure to COVID-19.


Furthermore, by signing below, the Participant or the Participant’s Guardian agrees that while attending or
participating in the Organization's events or attending at the Organization’s facilities, the Participant:


1. Will follow the safety, physical distancing and hygiene protocols of the Organization as outlined in the
BCWSA Return to Sport Guidelines for their sport.


2. Will, in the event that the Participant experiences any symptoms of illness such as a fever, cough,
difficulty breathing, shortness of breath or malaise, immediately:


a. Inform a representative of the Organization; and
b. Depart from the event or facility.


3. Acknowledges that the Organization may remove the individual from the facility or from participation
in the activities, programs or services of the Organization at any time and for any reason if the
Organization believes, in its sole discretion, that the individual is no longer in compliance with any of
the standards described in this document.

FOR PARTICIPANTS WHO HAVE BEEN DIAGNOSED WITH COVID-19

By signing below, the Participant (named below) or the Participant or the Participant’s Guardian attests that the Participant has been diagnosed with COVID-19, but been cleared as noncontagious by provincial or local public health authorities and has provided to the Organization, in conjunction with this COVID-19 DECLARATION OF COMPLIANCE, written confirmation from a medical doctor of the same.

This document will remain in effect until the Organization, per the direction of the provincial government and
provincial health officials, determines that the acknowledgements in this Declaration of Compliance are no
longer required.

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*

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*
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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