Community transmission of COVID-19 is occurring throughout the United States. In the coming months,
more of the United States population could be exposed to COVID-19. In order to safeguard the participants
in Pro Ambitions Hockey, Inc. (“PA”) [NAME OF CAMP] (“Camp”), PA is taking
precautions to reduce the chances of a Covid-19 infection of participants in the Camp. Parents whose
children are participating in the Camp must review and sign this COVID-19 Participation Acknowledgment
Agreement in order for their children to attend the Camp.
Having read and understood this COVID-19 Participation Acknowledgment Agreement, I acknowledge
and agree to the following:
1. I have elected voluntarily to permit my child to participate in the Camp.
2. To the best of my knowledge, neither I nor any member of my immediate family, including the
child/children who will be attending the Camp have been exposed to anyone who is exhibiting
symptoms of or who has tested positive for COVID-19 within the past fourteen (14) days. I know
of no medical reason why my child should not participate in the Camp. I have completed and fully
submitted my healthcare forms as required by PA.
3. Within twenty-four (24) hours before my child and I attend the Camp, I will take my temperature
and my participating child’s temperature using a thermometer. If my temperature or my child’s
temperature is above 100.4℉, I will promptly report this temperature reading to PA staff.
4. On the day of the Camp and before my child enters the Camp, I agree to have my child’s
temperature taken by PA staff or rink facility personnel. I understand that if my child’s temperature
is above 100.4℉, my child will not be able to attend the Camp and will leave the Camp
5. I understand and agree that if another child in my child’s Camp group has a temperature above
100.4℉ when the temperature is taken on any day of the Camp, then none of the children in the
group will be able to attend the Camp.
6. I agree that I will not receive a refund for the cost of the Camp if I or my child am not able to
participate. I may receive a credit toward a future PA camp in accordance with PA policies.
7. I agree to practice and instruct my child to practice social distancing while participating in the
Camp. I will instruct my child to regularly wash his/her hands soon after touching surfaces,
equipment and objects that others may have touched at the Camp.
8. I agree to leave the Camp and not return during the Camp if I or my child experiences, or is believed
to be experiencing, any of these symptoms published by the CDC: cough, shortness of breath or
difficulty breathing, fever, chills, muscle pain, sore throat, and/or new loss of taste or smell. (See
9. I assume full responsibility for any liability, including personal injury, property damage, or death
that I, my child or my property may sustain as a result of my participation in the Camp.
10. Release from Liability. I hereby agree, on behalf of myself, my child(ren), my heirs and my
personal representatives or their heirs or personal representatives, to fully and forever discharge
and release PA and its affiliates, and their respective owners, partners, agents, operators, managers,
coaches, instructors, employees, and representatives (“Released Parties”) from any and all claims
I or my child(ren) may have or hereinafter have for any illness, injury, temporary or permanent
disability, death, damages, liabilities, expenses and or causes of action, now known or hereinafter
known in any jurisdiction in the world, attributable or relating in any manner to my child’s
participation at the Camp, whether caused by the negligence of PA or any of the Released Parties,
or by any other reason. I acknowledge and agree that this COVID-19 Release and Waiver of
Liability is intended to be, and is, a complete release of any responsibility of the Released Parties
for any and all illness (including COVID-19 or other communicable disease or illness), personal
injuries, temporary or permanent disability, death and or property damage sustained by me or my
child while attending and or participating in the Camp.
11. This COVID-19 Participation Acknowledgement Agreement will be governed by and interpreted
in accordance with the laws of the Commonwealth of Massachusetts without giving effect to the
principles of conflicts of law of such commonwealth. I agree that any action arising out of this
COVID-19 Participation Acknowledgement Agreement must be brought exclusively in a state or
federal court located in Suffolk County, in the Commonwealth of Massachusetts.
PARENT OR GUARDIAN SIGNATURE REQUIRED:
PARENT OR GUARDIAN (for minor child(ren)):
and on Behalf of Child(ren)