DECLARATION OF COMPLIANCE – COVID-19

APPENDIX #2

Individual Name (print):

 

Individual’s Parent/Guardian
(if the individual is younger than 18 years old) 

Email:

Telephone:

WARNING! ALL INDIVIDUALS ENTERING THE FACILITY AND/OR PARTICIPATING IN SANCTIONED ACTIVITIES MUST COMPLY WITH THIS DECLARATION

Curling Canada,

[insert name of PSO/TSO]

[insert name of Club]

(collectively the “Organization”) require the disclosure of exposure or illness is in order to safeguard the health and safety of all participants and limit the further outbreak of COVID-19. 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.