REC- MUSA - Covid-19 Terms and Conditions
Please fill this out daily for your participant
Sign in to Google to save your progress. Learn more
Email *
Mainland United Soccer Association (MUSA) COVID-19 RELEASE AND WAIVER OF LIABILITY:
This question is required.
*The undersigned acknowledges the contagious nature of the Coronavirus/COVID-19 and that public health authorities have recommended abiding by certain precautions, including social distancing. The undersigned further acknowledges that Mainland United Soccer Association (MUSA) has put in place preventative measures to reduce the exposure to and spread of the Coronavirus/COVID-19 through the adoption of the Mainland United Soccer Association (MUSA) COVID Health & Safety Plan. By executing this instrument, the undersigned acknowledges that he/she has read the Mainland United Soccer Association (MUSA) COVID Health & Safety Plan and agrees to abide by the provisions of the plan and consents to the use and disclosure of medical testing and information obtained as required in the plan. The Mainland United Soccer Association (MUSA) cannot guarantee that the student athletes, coaches, and staff members will not become infected with the Coronavirus/COVID-19 and the undersigned understands that the risk of exposure to or infection from the Coronavirus/COVID-19 may occur despite the precautions taken pursuant to the plan. For these reasons, the undersigned, as a condition of participation Mainland United Soccer Association (MUSA) in programs, hereby releases and agrees to hold harmless Mainland United Soccer Association (MUSA)and its officers, members and staff from, and hereby waives, any and all causes of action, claims, damages, costs, and expenses arising from Coronavirus/COVID-19 exposure or infection in connection with participation in  Mainland United Soccer Association (MUSA) programs. *
Required
Parent: please type your name here. This constitutes a legally binding signature in observance of the terms and conditions laid out in this form.
*Parent - please fill this out if your child is a minor.
Your Name
I agree to the terms and conditions in this form.
Player / Coach: please type your name here. *This constitutes a legally binding signature in observance of the terms and conditions laid out in this form.
I agree to the terms and conditions in this form.
Please select your division:                        This question is required. * *
Please select your player's birth year: *
Within the past 14 days, have you traveled outside of the United States OR visited any of the states that N.J. is currently requiring quarantining after visiting? https://covid19.nj.gov/faqs/nj-information/travel-information/which-states-are-on-the-travel-advisory-list-are-there-travel-restrictions-to-or-from-new-jersey *
Required
Have you or anyone in your household been diagnosed with COVID-19 within the last 14 days?                                       *
Required
Have you been in close proximity to anyone who has tested positive for COVID-19 within the last 14 days? *
Required
Have you had ANY of the following symptoms within the past 48 hours: Fever - Cough or sore throat - Shortness of breath - Nasal congestion - Loss of taste or smell - Chills - Head or muscle aches - Nausea, diarrhea, or vomiting - Pink eye. *
Required
Please attest that you have taken your temperature today and your temperature is below 100.4°F
Is your temperature confirmed to be under 100.4 °F? *
Required
I hereby certify that the responses provided above are true and accurate to the best of my knowledge, as of today. Furthermore, by submitting this form, I consent to allowing the Mainland United Soccer Association Board to evaluate the information I have entered into this form.
 *Parent - please fill this out if your child is a minor.
Today's Date: *
MM
/
DD
/
YYYY
I agree to the terms and conditions in this form.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms