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Declaration Of Compliance COVID


***This Declaration of Compliance must be completed by each participant prior to participating in any soccer activity.  If you have any of the symptoms listed below, the participant is not permitted to participate in any BMSA activities!*** 

Participant Name (Print):_________________________________________________________

Participant’s Parent/Guardian: ____________________________________________________
(if the participant is younger than the age of majority)

Email: ________________________________________________________________________

Phone Number:  ________________________________________________________________

The Belmont Minor Soccer Association (“BMSA”) requires the disclosure of exposure or illness in order to safeguard the health and safety of all soccer participants and limit the further spread 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.

A participant (or the participant’s parent/guardian, if the participant is younger than the age of majority) who is not in compliance with the terms and conditions outlined in this document will not be permitted to participate in the any of the BMSA’s activities.

I, the undersigned, being the participant named above and the participant’s parent/guardian (if the participant is younger than the age of majority), hereby acknowledge and agree to the terms and conditions outlined in this document:

1. That the coronavirus disease (“Covid-19”) has been declared a worldwide pandemic by the World Health Organization and is highly contagious.  The BMSA has put in place preventative measures to reduce the spread of Covid-19 and requires that all participants (or their parent/guardian, when applicable) to adhere to the compliance standards described in this document;

2. That the participant has not been diagnosed with Covid-19 or if the participant was diagnosed with Covid-19, the participant was cleared as noncontagious by provincial or local public health authorities;

3. That the participant has not travelled outside of Canada in the last 14 days;

4. That the participant has not been in contact with any persons who may have confirmed or suspected cases of having the Covid-19 in the last 14 days;

5. That the participant has not, nor has anyone in the participant’s household, experienced any signs or symptoms of Covid-19 in the last 14 days (including fever of 37.8C or higher, chills, cough that’s new or worsening, barking cough (making a whistling noise when breathing – croup), shortness of breath (out of breath, unable to breathe), sore throat, difficulty swallowing, runny nose, sneezing or nasal congestion (not related to seasonal allergies), lost sense of taste or smell, pink eye (conjunctivitis), headaches that are long lasting, digestive issues (nausea/vomiting, diarrhea, stomach pain), muscle aches, extreme tiredness (fatigue, lack of energy), or lack of appetite);

6. That if the participant experiences, or if anyone in the participant’s household experiences any signs or symptoms of Covid-19 after submitting this Declaration of Compliance, the participant will immediately self-isolate, notify an executive member of the BMSA, and not attend any of the BMSA’s facilities or activities until at least 14 days have passed since those symptoms were last present.  The participant cannot return to BMSA activities until they are cleared by a medical health physician or public health authority;

7. That the participant is attending or participating voluntarily in BMSA activities and understands the risks associated with Covid-19.  The participant (or the participant’s parent/guardian, on behalf of the participant when applicable) agrees to assume those risks, included but not limited to exposure and being infected;

8. That the participant will follow the safety, physical distancing, and hygiene protocols of the BMSA;

9. This document will remain in effect until the BMSA, as per the direction of the provincial government and provincial health officials, determines that the acknowledgements in this Declaration of Compliance are no longer required; and

10. The BMSA has the legal right to remove any participant from any BMSA soccer activities at any time and for any reason if the Association believes, in its sole discretion, that the participant is no longer in compliance with the terms and conditions outlined in this document.

Signature: _____________________________________ Date: _________________________
Participant (if the age of majority)

Signature: _____________________________________ Date: _________________________
Parent/Guardian (if the participant

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Willem Verhulst,
Apr 5, 2021, 2:34 PM
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