**Effective June, 2020, every participant must complete a self-declaration understanding.

*All restrictions outlined in this document are current as of August 31, 2021 and may change. By signing this document, you agree to follow all Government mandates and restrictions that are in place at the time and date of signing and all future changes/updates the Government of Alberta may impose.
(https://www.alberta.ca/coronavirus-info-for-albertans.aspx)

DECLARATION OF COMPLIANCE – COVID-19

WARNING!

ALL INDIVIDUALS ENTERING THE FACILITY AND/OR PARTICIPATING IN SANCTIONED ACTIVITIES MUST COMPLY WITH THIS DECLARATION

The City of Edmonton, the Edmonton Soccer Association and the soccer facilities located at:

17415 – 106A Avenue

12720 Victoria Trail

6520 Roper Road

14920 – 142 Street

(collectively the “Organization”) require the disclosure of exposure or illness is in order to safeguard the health and safety of all 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 18 years old) who is unable to agree to the terms outlined in this document is not permitted to enter the Organization’s facilities or participate in the Organization’s activities, programs, or services.

I, the undersigned being the participant named below or the participant’s parent/guardian (if the participant is younger than 18 years old), hereby acknowledge and agree to the terms outlined in this document:

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

2) The individual has not been diagnosed with COVID-19. OR If the individual was diagnosed with COVID-19, the individual was cleared as noncontagious by provincial or local public health authorities.

3) If the individual is a front-line worker (such as hospital staff, long term care staff, or other individual who interacts with individuals who have confirmed or suspected cases of COVID-19) or travels outside of Canada, the individual has worn proper and approved Personal Protective Equipment at all times whenever they interacted with an individual who has a confirmed or suspected case of COVID-19 in the last 14 days.

4) If the individual is not a front-line worker, they have not been exposed to a person with a confirmed or suspected case of COVID-19 in the last 14 days.

5) The individual is attending or participating voluntarily and understands the risks associated with COVID-19. The individual (or the individual’s parent/guardian, on behalf of the individual (when applicable)) agrees to assume those risks, including but not limited to exposure and being infected.

6) The individual has not, nor has anyone in the individual’s household, experienced any signs or symptoms of COVID-19 in the last 14 days (including fever, new or worsening cough, fatigue, chills and body aches, respiratory illness, difficulty breathing, nausea, vomiting or diarrhea, pink eye, or loss of taste or smell).

7) If the individual experiences, or if anyone in the individual’s household experiences, any signs or symptoms of COVID-19 after submitting this Declaration of Compliance, the individual will immediately isolate, notify the Organization, and not attend any of the Organization’s facilities, activities, programs or services until at least 14 days have passed since those symptoms were last experienced.

8) The individual is following recommended guidelines, including but not limited to, practicing physical distancing, trying to maintain separation of six feet from others, adhering to recognized hygiene best practices, and otherwise limiting exposure to COVID-19.

9) The individual will follow the safety, physical distancing and hygiene protocols of the Organization.

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

11) The Organization may remove the individual from the facility or from participation in the activities, programs or services of the Organization at any time and for any reason if the Organization believes, in its sole discretion, that the individual is no longer in compliance with any of the standards described in this document.

The information on this form is being collected by or on the behalf of Edmonton Soccer Associations (ESA) in accordance with PIPA (Personal Information and Protection Act). The information is being collected for the purpose(s) of administering insurance claims,  risk management and legal matters.  In the event of an insurance claim, potential litigation or litigation, this information may be provided to the appropriate insurance company, Alberta Soccer Association or the league in which the individual is registered, and/or legal counsel, and other groups deemed necessary for the administration/arbitration of the claim. Should you have any questions regarding the collection of your personal information please contact Edmonton Soccer Association, This e-mail address is being protected from spambots. You need JavaScript enabled to view it.