I, the parent/guardian,of the following minor(s):

​
 

 

 

 

 

 

 

 

​

​

 

Representations


 

 

I, 
 

(parent’s name) hereby make the following representations on my behalf and on behalf of any minor child in my household (“My Household”):

​

a. My Household understands the hazards posed by COVID-19, is familiar with the Centers for Disease Control and Prevention (“CDC”) guidelines regarding COVID-19, has read the Sorrento VIA COVID policy, and will comply with all regulations designed to limit the risk of viral transmission while in a VIA sponsored activity.  We understand that the circumstances regarding COVID-19 are changing from day to day and that, accordingly, the CDC guidelines are regularly modified and updated, and we accept full responsibility for remaining familiar with the most recent updates.

​

b. My Household is not currently exhibiting any of the following symptoms (the “Symptoms”), associated with COVID-19: fever, coughing, shortness of breath, chills, muscle pain, sore throat, or loss of taste or smell.

​

c. If our child(ren) has ever exhibited Symptoms, they have tested negative OR they have isolated for at least 5 full days since the onset of the Symptoms, their symptoms are improving,  and they have been fever-free without fever-suppressing medication for at least 24 hours. 

​

d. If, after signing this document, our child(ren) exhibit Symptoms, they will not attend any VIA activities, until the conditions set forth in (c) above have been satisfied.

 

e. After exhibiting Symptoms and completing at least 5 full days of isolation since the onset of them and at least 24 hours of being fever-free without the use of fever-suppressing medication, my child(ren) will wear a mask when attending any VIA activities until 10 full days after onset of Symptoms or until two negative tests have been administered 48 hours or more apart.

 

f. If my child(ren) has been exposed to someone with COVID-19, they will wear a mask when indoors in any VIA activity until 10 full days after last exposure. 

​

g. My Household understands that the VIA is relying on the representations contained herein, in order to permit My Household to participate in activities, and will notify VIA staff of any Household situations related to COVID. 

​

h. My Household understands that if it has been untruthful about any of the representations contained in this document, its access to VIA activities may be suspended until my Household can demonstrate that it is complying with its representations.

​

Liability Release and Indemnification

​

I consent to minor’s participation in the activities and acknowledge that the minor and I fully understand minor’s participation may involve risk of serious injury or death, including losses or harm from: minor’s own actions, inactions, or negligence; the actions, inactions, or negligence of others; the condition of the facilities, equipment, or areas where the activities are being conducted; and/or the rules of play of this type of event or activity. I understand that if I have any risk concerns, I should discuss the risk associated with minor’s participation with the instructors before I sign this document and before any activities begin.

​

In consideration of allowing minor to participate in the activities, I hereby release and hold harmless The Sorrento Yacht Club, Sorrento Village Improvement Association, their members of the respective boards of trustees, officers, employees, volunteers, other participants, and agents collectively, the (“Released Parties”), of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that minor or I may have or sustain, whether individually or on minor’s behalf, with respect to any and all damage and/or injury, of any type, arising out of minor participating in the activities. I also agree that if any portion of this argument is held to be invalid the balance shall continue in full force and effect.

​

The undersigned further agree to hold harmless, indemnify, and save the Released Parties from any and all claims, demands, losses, damages, and liabilities for indemnities, contribution, or otherwise with respect to any damage and/or injury of any type arising from minor’s participation in the activities. The undersigned also agree that this Agreement in all parties extends to all acts by the Released Parties, with the exception of gross negligence or intentional misconduct and is intended to be as broad and inclusive as is permitted by the laws of the State of Maine in which the activities are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall continue in full legal force and effect.

​

I certify that minor is in good health and has no physical condition that would prevent participation in activities. Furthermore, I agree to use my/minor’s personal medical insurance as a primary medical coverage payment if accident or injury occurs. I consent to emergency medical treatment in the event such care is required.