Liability Waivers and Assumption of Risk Documents
General Liability Waiver and Assumption of Risk
In agreeing to participate in the program, as parent or guardian of Participant, I do hereby affirm that Participant’s general health is good and is not adversely affected by exercise. Participant is capable of performing activities of this nature.
For the opportunity to be a part of this program, I understand that I am responsible for my conduct and my child’s conduct at all times. I will not berate, curse, defame or confront a coach, participants, other coaches, umpires or referees, or anyone associated with the youth program or allow my child to do so. Parent/Guardian is responsible for following the rules and regulations of a suspension from the participant’s school. The Participant will not be allowed to participate in Madison County Parks and Recreation Authority Programs/Sports/Events if they are suspended after school hours from their school or excluded from extra-curricular activities due to their suspension from their school.
It is likewise assumed and agreed that I will, at my own expense, make sure Participant wears proper clothing and protective equipment during activities, and that it is the responsibility of myself, as Parent or Guardian of participant, to make sure the criteria are met. I also agree to allow transportation to the nearest physician or hospital for medical treatment and agree to allow for immediate first aid if and when deemed necessary.
I am also agreeing to allow my child's photograph to be used on the MCPRA website, www.hooverridge.com or any publication (i.e. newsletters, brochures) we may have for programs and events. I may choose to opt out by writing a letter to MCPRA or e-mailing Lindsay Von Herbulis at [email protected].
In consideration of participating in this activity, I do assume all risk of any injury and will indemnify and hold harmless, from any and all liability, action, cause of action, claims and demands of every kind or nature whatsoever that I have or which arise from or in connection with Participants involvement in this activity, the County of Madison, VA, the County Board of Supervisors, the Madison County Parks and Recreation Authority, the Madison County School Board and all officers, agents, employees, staff, volunteers and successors.
I understand that if I violate any of the above, I can be suspended from being at practices/games by the sport’s commissioner or by the Madison County Parks and Recreation Manager.
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization, resulting in the Governor of Virginia declaring a state of emergency in the Commonwealth of Virginia. COVID-19 is extremely 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.
Madison County Parks and Recreation Authority (MCPRA) has created new protocols and put in place preventative measures to reduce the spread of COVID-19; however, MCPRA cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending any program may increase you or your child(ren)s risk of contracting COVID-19.
COVID-19 spread mainly among people who are in close contact (within about 6 feet) for a prolonged period. Spread happens when an infected person coughs, sneezes, or talks, and droplets from their mouth or nose move through the air onto another person or a surface or object the other person subsequently touches while the virus remains live. Anyone can get or spread the virus. Everyone has a role to play in slowing the spread of the virus and protecting themselves, their family and the community.
Federal, Commonwealth, and local agencies recommend social distancing, masks, and other measures to minimize the risk of spread of COVID-19. MCPRA cannot completely mitigate the transfer of communicable diseases like COVID-19 especially when involved in sports or other extracurricular activities. Participation in such activities includes possible exposure to an illness, injury, or death from infectious diseases including COVID-19.
MCPRA will conduct certain extracurricular activities beginning in the Summer of 2020 and continuing into 2021. These activities (hereinafter referred to as “Activity”) will be conducted with safety protocols appropriate under the circumstances at the time. For the safety of all people involved, participants in the Activity will be required to adhere to all safety protocols and are subject to immediate removal from the Activity if they do not comply. Participation in extracurricular activities is a privilege, and not a right, and the safety of our instructors, coaches, referees, staff, and other participants is of utmost importance.
To promote the safety and wellness of our community, I understand the importance of taking responsible steps to promote health and safety when participating in an Activity. By signing below, I agree I will undertake the following Precautions as a condition of participation of myself and/or my child(ren) (collectively referred to as “Participant”) in the Activity:
By signing this document, I acknowledge and affirm my commitment to follow and meet the Precautions above as a condition of the Participant’s(’) participation. Further, I understand and agree Participant may be refused participation if it comes to the attention of MCPRA the Precautions have not been followed or met.
I also understand and acknowledge that despite the Precautions and other measures undertaken by MCPRA and others involved in the Activity, Participant remains at risk of contracting COVID-19 due to participation in the Activity, which risk is elevated depending on how much physical proximity is inherently involved in the Activity. I voluntarily assume the risk that I and/or the Participant(s) may be exposed to or infected by COVID-19 as a result of participation in the Activity, and that such exposure or infection may result in the symptoms identified above, as well as personal injury, illness, sickness, and/or death to myself, the Participant(s) and others we may be in contact with in the normal course of our lives (coworkers, other family members, neighbors, friends). I understand that the risk of exposure or infection may result from acts and omissions of myself, Participant(s), MCPRA staff, volunteers, or agents, other Activity participants, or others not listed. By signing this document, I expressly acknowledge and agree to assume all such risks in connection with the Participant(s) participation in the Activity.
Finally, I acknowledge that the above Precautions and guidelines applicable to the Activity may change at any time due to recommendations by the CDC, the Commonwealth of Virginia, the Department of Health, the Madison County Board of Supervisors, the Madison County Parks and Recreation Authority Board, or any other regulating entity. I acknowledge and accept the possibility that the Activity may be truncated, drastically altered, or eliminated in the future, even mid-season, due to such recommendations.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) 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) may experience or incur in connection with my child(ren)s attendance at the MCPRA program. In consideration of the Participant(s) being able to participate in the Activity, I, on my own behalf and on behalf of the Participant(s), hereby waive, release, and hold harmless Madison County Board of Supervisors, the County of Madison, Madison County Parks and Recreation Authority, and its employees and agents from any and all risks, claims, causes of actions, fees, costs, and any expenses of any sort or kind from exposure to and/or infection from COVID-19, that I and/or the Participant(s), or my or our representatives, have assumed hereunder or sustain during, after, or related to the Participant’s(’) participation or involvement in the Activity.
Parent Rules and Guidelines
1. I will not force my child to participate.
2. I will remember that the children participate to have fun and learn valuable skills and the game is for the youth and not the adults.
3. Parent/Guardian is responsible for providing a contact number that they/or designee may be reached at, if they will not be attending game/practice that day. This is for emergency reasons, weather conditions, etc.
4. I will learn the rules of the sport and policies of the league.
5. I will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy and by demonstrating positive support for all involved in the activity, including refraining from using social media to voice complaints and frustrations.
6. I will not engage in any kind of unsportsmanlike conduct with any official, coach, player or parent, including booing, taunting, using profanity or obscene gestures.
7. I will not encourage any behaviors or practices that would endanger the health and well-being of the athletes.
8. I will teach my child to play by the rules and resolve conflicts without resorting to hostility or violence.
9. I will demand my child to treat all other players, coaches, officials and spectators with respect.
10. I will refrain from ridiculing or yelling at my child or other child for making a mistake or losing a competition.
11. I will respect the officials and their authority during games and will never question, discuss or confront coaches or officials at the game field. I will take time to speak with coaches or officials at an agreed upon time and place
1 I will demand a sports environment from my child that is free from drugs, tobacco and alcohol and will refrain from use at all practices and events
13. I will refrain from coaching my child or other players during games and practices unless I am one of the official coaches of the team.
14. I, as Parent and/or Guardian, will behave in a manner respectful to coaches, officials, commissioners, and Parks and Recreation Staff. I understand that any behaviors deemed inappropriate by the above may be subject to review by the Board for the participant's sport or the Parks and Recreation Board. I understand that inappropriate behavior may result in suspension from Parks and Recreation Activities for a length of time.
Hoover Ridge Summer Camp Parent Responsibility Rules and Guidelines
1. I will not force my child to participate.
2. I will remember that the children participate to have fun and learn valuable skills and the activities are for the youth and not the adults.
3. Parent/Guardian is responsible for providing a contact number where they/or designee may be reached. This is for emergency reasons, weather conditions, etc.
4. I will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy and by demonstrating positive support for all involved in the activity, including refraining from using social media to voice complaints and frustrations.
5. I will not encourage any behaviors or practices that would endanger the health and well-being of the athletes.
6. I will teach my child to play by the rules and resolve conflicts without resorting to hostility or violence.
7. I will demand my child to treat all other participants and Parks and Recreation staff with respect.
8. I will make sure my child is equipped for the day's activities by providing appropriate clothing, shoes, sunscreen, food, water, and any other items designated by camp staff.
9. I will not allow my child to bring electronic devices, inappropriate items, or valuable items from home. I understand that these items may be confiscated by camp staff and will be returned to a parent at the end of the day.
10. I, as Parent and/or Guardian, will behave in a manner respectful to Parks and Recreation Staff and require my child participant to do the same. I understand that any behaviors deemed inappropriate by the staff may be subject to review by the Parks and Recreation Manager or the Parks and Recreation Board. I understand that inappropriate behavior may result in suspension from Parks and Recreation Activities for a length of time.
Women’s Volleyball Waiver
In agreeing to participate in the program, as participant or a parent or guardian of a participant, do hereby affirm that the general health of I/participant is good, I/participant is not adversely affected by exercise and that I/participant is capable of performing an activity of this nature.
In consideration of participating in this activity, I/participant do hereby assume all risk of any injury to the myself/participant and will indemnify and hold harmless, from any and all liability, action, cause of action, claims and demands of every kind or nature whatsoever that I/participant have or which arise from or in connection with participation in this activity, the County of Madison, VA, the County Board of Supervisors, the Madison County Department of Parks and Recreation and all their officers, agents, employees, staff, volunteers and successors.
It is likewise assumed and agreed that I/participant will, at his own expense, wear the proper clothing and protective equipment during the activity and that it is the responsibility of the participant or parent or guardian to make sure the criteria are met. I agree to allow transportation of the myself/participant to the nearest physician or hospital for medical treatment and agree to allow for immediate first aid to the injured participant, if and when deemed necessary.
In agreeing to participate in the program, as parent or guardian of Participant, I do hereby affirm that Participant’s general health is good and is not adversely affected by exercise. Participant is capable of performing activities of this nature.
For the opportunity to be a part of this program, I understand that I am responsible for my conduct and my child’s conduct at all times. I will not berate, curse, defame or confront a coach, participants, other coaches, umpires or referees, or anyone associated with the youth program or allow my child to do so. Parent/Guardian is responsible for following the rules and regulations of a suspension from the participant’s school. The Participant will not be allowed to participate in Madison County Parks and Recreation Authority Programs/Sports/Events if they are suspended after school hours from their school or excluded from extra-curricular activities due to their suspension from their school.
It is likewise assumed and agreed that I will, at my own expense, make sure Participant wears proper clothing and protective equipment during activities, and that it is the responsibility of myself, as Parent or Guardian of participant, to make sure the criteria are met. I also agree to allow transportation to the nearest physician or hospital for medical treatment and agree to allow for immediate first aid if and when deemed necessary.
I am also agreeing to allow my child's photograph to be used on the MCPRA website, www.hooverridge.com or any publication (i.e. newsletters, brochures) we may have for programs and events. I may choose to opt out by writing a letter to MCPRA or e-mailing Lindsay Von Herbulis at [email protected].
In consideration of participating in this activity, I do assume all risk of any injury and will indemnify and hold harmless, from any and all liability, action, cause of action, claims and demands of every kind or nature whatsoever that I have or which arise from or in connection with Participants involvement in this activity, the County of Madison, VA, the County Board of Supervisors, the Madison County Parks and Recreation Authority, the Madison County School Board and all officers, agents, employees, staff, volunteers and successors.
I understand that if I violate any of the above, I can be suspended from being at practices/games by the sport’s commissioner or by the Madison County Parks and Recreation Manager.
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization, resulting in the Governor of Virginia declaring a state of emergency in the Commonwealth of Virginia. COVID-19 is extremely 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.
Madison County Parks and Recreation Authority (MCPRA) has created new protocols and put in place preventative measures to reduce the spread of COVID-19; however, MCPRA cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending any program may increase you or your child(ren)s risk of contracting COVID-19.
COVID-19 spread mainly among people who are in close contact (within about 6 feet) for a prolonged period. Spread happens when an infected person coughs, sneezes, or talks, and droplets from their mouth or nose move through the air onto another person or a surface or object the other person subsequently touches while the virus remains live. Anyone can get or spread the virus. Everyone has a role to play in slowing the spread of the virus and protecting themselves, their family and the community.
Federal, Commonwealth, and local agencies recommend social distancing, masks, and other measures to minimize the risk of spread of COVID-19. MCPRA cannot completely mitigate the transfer of communicable diseases like COVID-19 especially when involved in sports or other extracurricular activities. Participation in such activities includes possible exposure to an illness, injury, or death from infectious diseases including COVID-19.
MCPRA will conduct certain extracurricular activities beginning in the Summer of 2020 and continuing into 2021. These activities (hereinafter referred to as “Activity”) will be conducted with safety protocols appropriate under the circumstances at the time. For the safety of all people involved, participants in the Activity will be required to adhere to all safety protocols and are subject to immediate removal from the Activity if they do not comply. Participation in extracurricular activities is a privilege, and not a right, and the safety of our instructors, coaches, referees, staff, and other participants is of utmost importance.
To promote the safety and wellness of our community, I understand the importance of taking responsible steps to promote health and safety when participating in an Activity. By signing below, I agree I will undertake the following Precautions as a condition of participation of myself and/or my child(ren) (collectively referred to as “Participant”) in the Activity:
- Perform daily temperature checks on the Participant(s) to screen for fever before arrival for the Activity. Fever is defined as a temperature over 100.4 F or 38.0 C. If a Participant has a fever, I will not permit the Participant to participate in the Activity until he/she has been without a fever (without medical intervention) for at least 72 hours or receives a negative test for COVID-19. I also agree that the MCPRA also may screen Participants for a fever prior to allowing participation in any Activity.
- Inquire and/or make a visual or tactile inspection of Participant(s) for signs of illness which could include: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose unrelated to typical allergies, nausea or vomiting, diarrhea, flushed cheeks, rapid breathing or difficulty breathing (without recent physical activity), fatigue, extreme fussiness, or any other symptom now or hereafter recognized by the Centers for Disease Control (CDC) as a symptom of COVID-19. If a Participant has exhibited any of these signs or symptoms, I will not permit the Participant to participate in the Activity until he/she has been without signs or symptoms (without medical intervention) for at least 72 hours or receives a negative test.
- Confirm that no Participant has been in contact with someone who has either tested positive for COVID-19 in the past 14 days or is waiting for test results. If any Participant has been in contact with such a person, I will not permit the Participant to participate in the Activity until 14 days have elapsed since the time of contact and no symptoms have manifested in the Participant.
- Promptly pick up the Participant(s) or arrange for pickup if signs or symptoms of illness are reported by MCPRA. I understand that Participants are to remain home until released from any quarantine and illness-free for at least 72 hours without the use of medicine.
By signing this document, I acknowledge and affirm my commitment to follow and meet the Precautions above as a condition of the Participant’s(’) participation. Further, I understand and agree Participant may be refused participation if it comes to the attention of MCPRA the Precautions have not been followed or met.
I also understand and acknowledge that despite the Precautions and other measures undertaken by MCPRA and others involved in the Activity, Participant remains at risk of contracting COVID-19 due to participation in the Activity, which risk is elevated depending on how much physical proximity is inherently involved in the Activity. I voluntarily assume the risk that I and/or the Participant(s) may be exposed to or infected by COVID-19 as a result of participation in the Activity, and that such exposure or infection may result in the symptoms identified above, as well as personal injury, illness, sickness, and/or death to myself, the Participant(s) and others we may be in contact with in the normal course of our lives (coworkers, other family members, neighbors, friends). I understand that the risk of exposure or infection may result from acts and omissions of myself, Participant(s), MCPRA staff, volunteers, or agents, other Activity participants, or others not listed. By signing this document, I expressly acknowledge and agree to assume all such risks in connection with the Participant(s) participation in the Activity.
Finally, I acknowledge that the above Precautions and guidelines applicable to the Activity may change at any time due to recommendations by the CDC, the Commonwealth of Virginia, the Department of Health, the Madison County Board of Supervisors, the Madison County Parks and Recreation Authority Board, or any other regulating entity. I acknowledge and accept the possibility that the Activity may be truncated, drastically altered, or eliminated in the future, even mid-season, due to such recommendations.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) 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) may experience or incur in connection with my child(ren)s attendance at the MCPRA program. In consideration of the Participant(s) being able to participate in the Activity, I, on my own behalf and on behalf of the Participant(s), hereby waive, release, and hold harmless Madison County Board of Supervisors, the County of Madison, Madison County Parks and Recreation Authority, and its employees and agents from any and all risks, claims, causes of actions, fees, costs, and any expenses of any sort or kind from exposure to and/or infection from COVID-19, that I and/or the Participant(s), or my or our representatives, have assumed hereunder or sustain during, after, or related to the Participant’s(’) participation or involvement in the Activity.
Parent Rules and Guidelines
1. I will not force my child to participate.
2. I will remember that the children participate to have fun and learn valuable skills and the game is for the youth and not the adults.
3. Parent/Guardian is responsible for providing a contact number that they/or designee may be reached at, if they will not be attending game/practice that day. This is for emergency reasons, weather conditions, etc.
4. I will learn the rules of the sport and policies of the league.
5. I will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy and by demonstrating positive support for all involved in the activity, including refraining from using social media to voice complaints and frustrations.
6. I will not engage in any kind of unsportsmanlike conduct with any official, coach, player or parent, including booing, taunting, using profanity or obscene gestures.
7. I will not encourage any behaviors or practices that would endanger the health and well-being of the athletes.
8. I will teach my child to play by the rules and resolve conflicts without resorting to hostility or violence.
9. I will demand my child to treat all other players, coaches, officials and spectators with respect.
10. I will refrain from ridiculing or yelling at my child or other child for making a mistake or losing a competition.
11. I will respect the officials and their authority during games and will never question, discuss or confront coaches or officials at the game field. I will take time to speak with coaches or officials at an agreed upon time and place
1 I will demand a sports environment from my child that is free from drugs, tobacco and alcohol and will refrain from use at all practices and events
13. I will refrain from coaching my child or other players during games and practices unless I am one of the official coaches of the team.
14. I, as Parent and/or Guardian, will behave in a manner respectful to coaches, officials, commissioners, and Parks and Recreation Staff. I understand that any behaviors deemed inappropriate by the above may be subject to review by the Board for the participant's sport or the Parks and Recreation Board. I understand that inappropriate behavior may result in suspension from Parks and Recreation Activities for a length of time.
Hoover Ridge Summer Camp Parent Responsibility Rules and Guidelines
1. I will not force my child to participate.
2. I will remember that the children participate to have fun and learn valuable skills and the activities are for the youth and not the adults.
3. Parent/Guardian is responsible for providing a contact number where they/or designee may be reached. This is for emergency reasons, weather conditions, etc.
4. I will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy and by demonstrating positive support for all involved in the activity, including refraining from using social media to voice complaints and frustrations.
5. I will not encourage any behaviors or practices that would endanger the health and well-being of the athletes.
6. I will teach my child to play by the rules and resolve conflicts without resorting to hostility or violence.
7. I will demand my child to treat all other participants and Parks and Recreation staff with respect.
8. I will make sure my child is equipped for the day's activities by providing appropriate clothing, shoes, sunscreen, food, water, and any other items designated by camp staff.
9. I will not allow my child to bring electronic devices, inappropriate items, or valuable items from home. I understand that these items may be confiscated by camp staff and will be returned to a parent at the end of the day.
10. I, as Parent and/or Guardian, will behave in a manner respectful to Parks and Recreation Staff and require my child participant to do the same. I understand that any behaviors deemed inappropriate by the staff may be subject to review by the Parks and Recreation Manager or the Parks and Recreation Board. I understand that inappropriate behavior may result in suspension from Parks and Recreation Activities for a length of time.
Women’s Volleyball Waiver
In agreeing to participate in the program, as participant or a parent or guardian of a participant, do hereby affirm that the general health of I/participant is good, I/participant is not adversely affected by exercise and that I/participant is capable of performing an activity of this nature.
In consideration of participating in this activity, I/participant do hereby assume all risk of any injury to the myself/participant and will indemnify and hold harmless, from any and all liability, action, cause of action, claims and demands of every kind or nature whatsoever that I/participant have or which arise from or in connection with participation in this activity, the County of Madison, VA, the County Board of Supervisors, the Madison County Department of Parks and Recreation and all their officers, agents, employees, staff, volunteers and successors.
It is likewise assumed and agreed that I/participant will, at his own expense, wear the proper clothing and protective equipment during the activity and that it is the responsibility of the participant or parent or guardian to make sure the criteria are met. I agree to allow transportation of the myself/participant to the nearest physician or hospital for medical treatment and agree to allow for immediate first aid to the injured participant, if and when deemed necessary.