Covid-19 Waiver

Name *

First

Last

Email *

Child's Name if applicable

First

Last

I understand the risk of contacting other people during the Covid-19 Global pandemic at activities held on the Vermilion Agricultural Society grounds. I understand that I could become infected while at said activity. I agree and assume all risk and release and absolve the Vermilion Agricultural Society and its affiliated officials, volunteers, offices, directors, agents, representatives and employees and the occupiers of the land upon which the activity is held, from all responsibility, liability or claims I may have to arise from participating in an in-person activity during the Covid-19 Pandemic. *

Yes
No

To your knowledge, have you or anyone in your household had contact of any kind with someone diagnosed with Covid-19 within the last 14 days? *

Yes
No

Are you experiencing any cold or flu-like symptoms, including but not limited to fever, cough, sore throat, respiratory illness, shortness of breath or difficulty breathing?

Yes
No

Have you or anyone in your household returned from any destination outside of Canada or travelled in an airplane from any destination within the last 14 days? *

Yes
No

I understand that should any circumstances reference in questions 2 through 4 arise, I have a duty to the Vermilion Agricultural Society to not join any in-person activities for a period of 14 days. I will inform the Vermilion Agricultural Society immediately of any changes necessary to this self-declaration. Upon re-entry, I am required to complete a new self-declaration. *

Yes
No

I have read, understood and will abide by the protocols set in place by AHS and the Vermilion Agricultural Society. *

Yes
No

Date *

Signature

Clear Signature

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