HIDE N SEEK PLAYGROUND EDMONTON COVID-19 Questionare ASSUMPTION OF RISKS I AM AWARE AND UNDERSTAND THAT THE ACTIVITIES INVOLVE MANY RISKS, DANGERS, AND HAZARDS, INCLUDING BUT NOT LIMITED TO RISK OR SERIOUS INJURY, DEATH, OR PROPERTY DAMAGE. I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITIES. I FREELY ACCEPT AND FULLY ASSUME ANY AND ALL OF THE RISKS, DANGERS, AND HAZARDS INVOLVED AND THE POSSIBILITY OF INJURY, DEATH, OR PROPERTY DAMAGE, WHETHER CAUSED BY THE NEGLIGENCE OF THE COMPANY OR OTHERWISE. I hereby expressly waive and release any and all claims which I have or may have in the future against the Company, its affiliates, and their respective directors, officers, employees, agents, representatives, contractors, shareholders, successors, and assigns (collectively, the “Releases”), on account of any injury, death, or property damage arising out of or attributable to my participation in the Activities, due to any cause whatsoever, including without limitation the negligence of the Company or any other Releasee, breach of contract, or breach of any statutory or other duty of care owing under occupiers liability legislation or otherwise. I covenant not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releases from liability under such claims. I shall defend, indemnify, and hold harmless the Company and all other Releases against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interests, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable legal fees, in connection with any third-party claim, suit, action, or proceeding arising out of or resulting from my participation in the activities. This Agreement constitutes the entire agreement of the Company and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is held to be invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision in any other jurisdiction. This agreement is binding on and shall ensure to the benefit of me and my heirs, and next-of-kin, and the Company, and its successors and assigns. This Agreement is to be governed by and construed in accordance with the laws of the Province of Alberta and the laws of Canada where applicable. Any claim or cause of action arising under this Agreement may be brought only in the courts of the Province of Alberta, and I hereby consent to exclusive jurisdiction of such courts. I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY WAIVING SUBSTANTIAL LEGAL RIGHTS (ON MY BEHALF, AND ON BEHALF OF MY HEIRS, EXECUTORS, ADMINISTRATORS, AND NEXT-OF KIN), INCLUDING THE RIGHT TO SUE THE COMPANY AND THE RELEASEES. By checking the box, you legally agree to the above. <--Please Check if you agree with the waiver Hide N Seek playground Edmonton COVID-19 SCREENING CHECKLIST Does the person attending the activity, have any of the below symptoms (Q1 - Q14): YES / NO Q1 Fever YESNO Q2 Cough YESNO Q3 Shortness of Breath/Difficulty Breathing YESNO Q4 Sore Throat YESNO Q5 Chills YESNO Q6 Painful Swallowing YESNO Q7 Runny Nose/Nasal Congestion YESNO Q8 Feeling Unwell/Fatigued YESNO Q9 Nausea/Vomiting/Diarrhea YESNO Q10 Unexplained loss of appetite YESNO Q11 Loss of sense of taste or smell YESNO Q12 Muscle/Joint Aches YESNO Q13 Headache YESNO Q14 Conjunctivitis YESNO Q15. Have you, or anyone in your household, travelled outside of Canada in the last 14 days? YESNO Q16. Have you or your children attending the program had close unprotected* contact (face-to-face contact within 2 metres/6 feet) with someone who is ill with cough and/or fever? YESNO Q17. Have you or anyone in your household been in close unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? YESNO If you have answered “YES” to any of the above questions do not participate in-Person Class. In addition, my child and I have read and reviewed Hide N Seek playground Edmonton’s Covid-19 Procedural Guide and Protocols provided to me over this form and through Hide N Seek playground Edmonton’s website at www.hanulartschool.com. My child and I will do the COVID-19 screening check list before attend the Hide N Seek playground Edmonton. I confirm that I have read and fully understand the guidelines regarding the Screening Checklist above as well as the Hide N Seek playground Edmonton Covid-19 Procedural Guide and Protocols and will abide by the policies listed. By checking the box, you legally agree to the above. <--Please Check if you agree with the check list Participant Information First Name: Last Name: Date of Birth:(mm/dd/yyyy) School: Grade(required): PreschoolJr.KindergartenKindergartenGr1Gr2Gr3Gr4Gr5Gr6Gr7Gr8Gr9Gr10Gr11Gr12 Parent / Guardian Information First Name: Last Name: Phone: E-Mail: Address: City: Province: AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territories Postal code: If the submit button is not working, please check the two RED texts above(check box for agreement).
