COVID-19 Disclosure and Informed Consent Agreement
(Addendum to Adaptive Sports Center Waiver and Release of Liability Agreement)
Statement from the Adaptive Sports Center of Crested Butte: Dear participant, as you know it is our mission to enhance the quality of life of people with disabilities through exceptional outdoor adventure activities. According to the Center for Disease Control (CDC), many of our participants with disabilities may be at a higher risk of severe illness associated with COVID-19 and should take extra precautions to avoid exposure. For detailed guidance we encourage you to visit: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html Because of the heightened risk, it is important that we disclose to you information associated with COVID-19 so that you can make a careful, informed decision about whether or not you should currently participate in adaptive sports activities with us. We invite you to contact the Adaptive Sports Center and we will make every effort to answer all of your questions. We highly recommend that you consult with your doctor before making any decision to participate with us.
From the Center for Disease Control and Prevention (CDC):
COVID-19 is a new disease and there is limited information regarding risk factors for severe disease. Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19. Source: Center for Disease Control and Prevention; https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html
Based on what we know, risk for severe illness with COVID-19 increases with age, obesity, and older adults (>65) being at the highest risk.
Adults of any age with the following conditions are at increased risk of severe illness from the virus that causes COVID-19:
- Cancer
- Chronic kidney disease
- COPD (chronic obstructive pulmonary disease)
- Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
- Immunocompromised state (weakened immune system) from solid organ transplant
- Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
- Severe Obesity (BMI ≥ 40 kg/m2)
- Pregnancy
- Sickle cell disease
- Smoking
- Type 2 diabetes mellitus (Source: Center for Disease Control and Prevention).
Disclosure by the Adaptive Sports Center regarding Coronavirus (COVID-19) Risks:
Because of the coronavirus outbreak, it is highly likely that your experience with us may be substantially different than it was prior to the coronavirus outbreak. This is due to our modified activity guidelines connected to our effort to keep both our participants and instructors safe from contracting COVID-19. Please be aware that we will adhere to Federal, State and County minimum standards and guidelines for safe social distancing, mask-wearing, sanitation and other requirements for the prevention of COVID-19. We may also implement stricter guidelines as we deem necessary for the safety of our participants and instructors. Because of these changes, you must agree and consent as follows:
Please read carefully before initialing and signing below: This document waives certain rights and releases the Adaptive Sports Center from liability.
Initial Here I shall provide proof of full vaccination or a negative COVID-19 test taken within 5 days of my first activity with the Adaptive Sports Center
Initial Here I understand that I will not be allowed to participate with the Adaptive Sports Center if I am experiencing any signs or symptoms of any illness and shall notify the Adaptive Sports Center immediately of any such signs or symptoms of illness.
Initial Here I understand that my outdoor adventure and experience may be substantially modified by and will be subject to the safety guidelines implemented by the Adaptive Sports Center and at Adaptive Sports Center discretion. I acknowledge that I have had the opportunity to speak with the Adaptive Sports Center staff who has made every effort to answer all my questions.
Initial Here I consent to and agree to abide by any and all safety guidelines and practices required by the Adaptive Sports Center before and during my participation in outdoor activities with the Adaptive Sports Center, including but not limited to, disclosing requested health information, adhering to social distancing and mask wearing as well as other COVID-19 mitigation requirements of the Adaptive Sports Center and that the coronavirus mitigation standards of the State of Colorado, County of Gunnison and the Adaptive Sports Center may be different from my place of residence.
Initial Here I acknowledge that I have been fully informed of the risks and dangers associated with my potential exposure to the coronavirus while traveling to and from Gunnison County and during my participation in lessons with the Adaptive Sports Center. Specifically, I am aware that I may be included in the category of persons the CDC deems to be at a higher risk of severe illness from the coronavirus and that I should consult with my doctor before making any decision to participate. By choosing to participate in the Adaptive Sports Center activities, I voluntarily assume the risk of exposure to the coronavirus.
Initial Here I exempt, waive and release the Adaptive Sports Center from any and all liability for any harm, personal injury, claim or cause of action that may arise due to the coronavirus outbreak.
Initial Here I acknowledge that I have had the opportunity to consult with my physician and with the Adaptive Sports Center staff before signing this form. I further acknowledge and agree that I have read this document in its entirety and that I understand and agree with the terms and content of this Disclosure and Informed Consent Agreement.
CERTIFICATION
I hereby certify that all of the information and questionnaire responses provided in connection with my registration to participate in Adaptive Sports Center activities are true, accurate and complete to the best of my knowledge. I understand that the Adaptive Sports Center has the right to deny participation to me if I am deemed to pose an unreasonable risk to the health, safety and welfare of myself, other clients, the Adaptive Sports Center staff and volunteers, health care providers and other first responders, or members of the community.