Communicable Diseases Waiver Participant First Name Last Name Participant Birth Date (MM/DD/YYYY) Participant Role Athlete Athlete in training (under 8 years old and participates in local area training/competition)Coach Unified partner VolunteerYoung Athlete (ages 2-7 and participates in a Community Young Athlete Program) Area/ CountyPlease select... Area 01 (Hudson) Area 02 (Passaic) Area 03 (Sussex, Morris) Area 04 (Hunterdon,Warren) Area 05 (Union , Middlesex) Area 06 (Ocean, Monmouth) Area 07 (Camden, Gloucester, Salem) Area 08 (Atlantic, Cape May, Cumberland) Area 09 (Essex) Area 10 (Somerset) Area 11 (Mercer) Area 12 (Bergen) Area 13 (Burlington) E-mail Phone Phone Type HomeMobile Waiver and Release of Liability, Assumption of Risk and Indemnification Agreement for Communicable Diseases ("Agreement") for Special Olympics New Jersey In consideration of being allowed to participate in any way in Special Olympics sports training, competition or fundraising activities, the undersigned acknowledges, appreciates, and agrees that: TitleParticipation includes possible exposure to and illness from infectious and/or communicable diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Special Olympics, Inc, Special Olympics New Jersey, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. Signature TypeParticipant Signature (Required for adult (age 18 and older) participants, including adult athlete with capacity to sign documents - e.g. the athlete is their own guardian)Parent/ Guardian Signature (Required for participant who is a minor (younger than age 18) or lacks capacity to sign documents.) TitleTitle Participant Signature Required for adult (age 18 and older) participants, including adult athlete with capacity to sign documents. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Signature (By signing this Communicable Diseases Waiver electronically, you agree your electronic signature is the legal equivalent of your manual signature.) Today's Date (MM/DD/YYYY) Parent/ Guardian Signature For participants of minority age (under age 18 at the time of registration) or those over 18 without the capacity to sign for themselves. This is to certify that I, as parent/guardian with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child's/ward's presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law. Parent/ Guardian Signature (By signing this Communicable Diseases Waiver electronically, you agree your electronic signature is the legal equivalent of your manual signature.) Today's Date (MM/DD/YYYY) Relationship
