Fencer Name *

First Name

Last Name

Parent | Guardian Name ( if above is minor)

First Name

Last Name

I am filling out this form for

My child

Myself

Mobile no. *

(###)

###

####

If filling out for your child, are they fully vaccinated? If this form is for yourself, are you fully vaccinated? (2+ weeks of final dose) *

Yes

No

If you are guest or visitor, please indicate date of your visit:

MM

DD

YYYY

1. You agree to fill out this form truthfully and will not knowingly hide an illness. You (or your fencer) agree to properly execute hygiene protocols at RedStar Fencing Club Chicago, which includes any mask mandates. Furthermore, you should be aware that wearing personal face coverings during exercise may have risks, and should contact a healthcare provider to discuss these risks. You understand that failure to disclose correct information on this form could lead to serious illness or possible death of another person. RedStar Fencing Club Chicago is taking these steps to protect the health of its membership, and you release RedStar Fencing Club and its membership from any claims resulting from illness.

I AGREE

2. You agree to follow the current Chicago Travel Order. Please inform us of your travel plans: https://www.chicago.gov/city/en/sites/covid-19/home/emergency-travel-order.html. Fully vaccinated persons (2+ weeks after final dose) who are asymptomatic, may bypass quarantine. You may also test-out on days 3-5 upon your return.

I AGREE

3. You agree to stay home if you, your fencer, or anyone in your immediate household present any symptoms that are unexplained, or out of your normal baseline. You agree to stay home if you have new, current, or worsening symptoms in the past 24-hours including: ○ Fever of 100.4 or higher ○ Cough ○ Sore throat ○ Chills ○ unexplained muscle aches ○ Nausea or vomiting Diarrhea ○ Difficulty breathing ○ Shortness of breath ○ New loss of taste or smell

I AGREE