Icehawks Player Questionnaire
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Email *
Player Name (if no player, enter NONE) *
Guardian Name *
School / Rink *
Date of Game *
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Team name *
By checking these boxes, I am confirming that NEITHER THE PLAYER (if any), NOR MYSELF currently has or has had any of these symptoms in the last 14 days: *
Required
Within the last 14 days, NEITHER THE PLAYER (if any), NOR MYSELF has returned from a state on the NY/NJ/CT State Travel* Advisory List (NY/NJ/CT State Travel Advisory List currently lists following states: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Guam, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, North Carolina, North Dakota, Oklahoma, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming.) *
Required
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is highly contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. The South Kent School Corporation (SKS) and the Northwestern Connecticut Youth Hockey and Skating Association (NWCTYH) have put in place preventative measures to reduce the spread of COVID-19 on the campus of SKS and in Stockdale Arena; however, SKS and NWCTYH cannot guarantee that you or your child(ren) (if any) will not become infected with COVID-19.  Further, participation in any events or activities offered by SKS and NWCTYH could increase your risk and your child(ren)’s (if any) risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) (if any) and I may be exposed to or infected by COVID-19 by attending events or activities offered by SKS and/or NWCTYH and that such exposure or infection may result in personal injury, illness, permanent disability, and death.  I understand that the risk of becoming exposed to or infected by COVID-19 while participating in events or activities at SKS may result from the actions, omissions, or negligence of myself and others, including, but not limited to, SKS and NWCTYH employees, volunteers, students, and event participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) (if any) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) (if any) may experience or incur in connection with my child(ren)’s (if any) attendance at or participation in events or activities on the school’s premises (“Claims”). On my behalf, and on behalf of my children (if any), I hereby release, covenant not to sue, discharge, and hold harmless SKS and NWCTYH, both singly and jointly, and their respective employees, volunteers, agents, and representatives, of and from any Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of SKS and NWCTYH, their employees, volunteers, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any event or activity that takes place at SKS, including Stockdale Arena. *
Required
Acknowledgements *
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A copy of your responses will be emailed to the address you provided.
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