Dodgeball Seattle COVID-19 Waiver

Seattle Dodgeball Waiver and COVID-19 Contract Trace

"*" indicates required fields

This form will be used to submit your waiver for participating in a Dodgeball Seattle sponsored event as well as a contact trace form for COVID-19 outbreaks. All Personally Identifiable Information will be removed within 30 days of submission.

READ BEFORE SIGNING

In consideration of being allowed to participate in any way in Dodgeball Seattle's sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
  1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
  2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
  3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
  4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Dodgeball Seattle their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
  5. In addition of being allowed to participate in any way in Dodgeball Seattle's sports program, related events and activities, the undersigned also acknowledges, appreciates, and agrees that:
  6. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,
  7. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
  8. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
  9. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (Dodgeball Seattle) their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Full Name*
Have you had or have any new COVID-19 symptoms such as: a cough, fatigue, shortness of breath, sore throat, muscle pain, gastrointestinal (nausea, vomiting, diarrhea), respiratory symptoms (i.e. running nose), chills, loss of taste/smell, a new headache which you cannot attribute to another health condition within the last 72 hours?*
Have you had a fever or temperature of 100.4 or higher in the last 72 hours?*
Have you been in contact with someone who has been experiencing symptoms or who was diagnosed with COVID-19 in the past 14 days? Close contact includes being within approximately 6 feet of a person with confirmed COVID-19 for a total of 15 minutes or more?*
Have you travelled internationally or to an area that requires a quarantine upon visiting or returning home?*
Are you waiting on test results of a COVID-19 test?*
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