COVID-19 Addendum

X-CEL ATHLETICS CHEER AND TUMBLE ACADEMY LLC, HOME OF STEP 1 ALLSTARS NORTH

LIABILITY WAIVER ADDENDUM FORM 2020-2021
First Name*
Last Name*
Email*
Phone*
IN CONSIDERATION for being permitted to utilize the services, and programs of the X-CEL Athletics Cheer and Tumble Academy, LLC ( "X-Cel") and/or for my child:
Child's Name*
to so participate for any purpose, including, but not limited to, observation or use of facilities or equipment and provision of coaching services, the undersigned, on behalf of himself or herself and such participating children and any personal representatives, heirs, and next of kin (hereinafter referred to as "the undersigned") hereby acknowledges, agrees and represents that he or she has inspected and carefully considered such premises, equipment and facilities and policies of X-Celand that the undersigned finds and accepts same as being safe and reasonably suited for the use or participation by the undersigned and such participating children.
In addition, the undersigned acknowledges that novel coronavirus (''COVID-19") infections have been confirmed throughout the United States, including a high volume of Cases in Ohio in general, and Northeast Ohio in specific. in. In accordance with the most recent guidance and protocols issued by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the Ohio of Health (MDHfor slowing the transmission of COVID-19, the undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of the X-Cel (other than any exclusively online services and programs) within 14 days after (i) returning from highly impacted areas subject to a CDC Level 3 Travel Health Notice, (ii) exposure to any person returning from areas subject to a CDC Level 3 Travel Health Notice, or (iii) exposure to any person who has a suspected or confirmed case of COVID-19. The CDC Travel Health Network is continuously updating this list and the undersigned agrees that they are aware of this list and the countries listed.
The undersigned agrees to check the CDC Travel Health Notices list
https://www.cdc.gov/coronavirus/2019-ncov/travelers/) prior to utilizing the facilities, services, and programs of the X-Cel, on a daily basis if necessary. The undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of X-Cel if he or she (i) experiences symptoms of COVID-19, including, without limitation, fever, cough or shortness of breath, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify X-Cel immediately if he or she believes that any of the foregoing access/use restrictions may apply.
The undersigned Specifically notes that they are required to know and observe all guidelines provided by the CDC and the State of Ohio as part of their and/or their children’s entrance, into, presence in or use of the facilities / services provided by X-Cel. Failure to maintain sound social distancing practices shall result in the removal of the undersigned and/or their children from the property.
The undersigned agrees to monitor the current best practices provided by the CDC and the State of Ohio. They can be accessed here:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://coronavirus.ohio.gov/wps/portal/gov/covid-19/home
X-Cel has taken certain steps to implement recommended guidance and protocols issued by the Public Health Agencies for slowing the transmission of COVID-19, including, without limitation, the access/use restrictions set forth above. The undersigned acknowledges and agrees that the X-Cel may revise its procedures at any time based on updated recommended guidance and protocols issued by the Public Health Agencies and further agrees to comply with the X-Cel's revised procedures prior to utilizing the facilities, services, and programs of X-Cel. The undersigned further acknowledges and agrees that, due to the nature of the facilities, services, and programs offered by X-Cel, social distancing of 6 feet per person among children and their caregivers in a childcare setting may not be possible.
ALLOW MY ATHLETE TO BE SPOTTED THROUGH A SKILL*
COACHES / INSTRUCTORS WILL TAKE EVERY NECESSARY PRECAUTION TO ENSURE THE SAFETY OF STUDENTS WHILE COMPLYING WITH THE STATE OF OHIO’S ACTIVE GUIDELNES. PART OF THE SAFETY IS THE ABILITY TO ASSIST (SPOT) YOUR ATHLETES THROUGH A SKILL WHEN NECESSARY. PLEASE SIGN YOUR NAME GIVING PERMISSION TO THE X-CEL ATHLETICS COACHES/INSTRUCTORS THAT THEY MAY PHYSCIALLY ASSIST (SPOT) YOUR ATHLETE. IN ADDITION YOU ARE ACKOWLEDGING THE CONTAGIOUS NATURE OF COVID-19 AND VOLUNTARILY ASSUME THE RISK THAT YOUR ATHLETE MAY BE EXPOSED TO BY WORKING WITH AN X-CEL ATHLETICS COACH/INSTRUCTOR.
- I AGREE TO ALLOW MY ATHLETE TO BE ASSISTED (SPOTTED) THROUGH A SKILL.
- UNTIL FURTHER NOTICE, I DO NOT WISH TO ALLOW MY ATHLETE TO BE SPOTTED THROUGH A SKILL AT THIS TIME.
Signature*
Date*
MM slash DD slash YYYY
The undersigned fully understands and appreciates both the known and potential dangers of utilizing the facilities, services, and programs of X-Cel and acknowledges that use thereof by the undersigned and/or such participating children may, despite X-Cel's reasonable efforts to mitigate such dangers, result in exposure to COVID-19, which could result in quarantine requirements, serious illness, disability, and/or death. IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER X-CEL FOR ANY PURPOSE INCLUDING, BUT NOT UMITED TO, OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY ON-SITE OR OFF-SITE PROGRAM AFFIUATED WITH X-CEL, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING: THE UNDERSIGNED, ON HIS OR HER BEHALF AND ON BEHALF OF SUCH PARTICIPATING CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE X-Cel, its directors, officers, employees, volunteers and agents from all liability to the undersigned or such participating children and all personal representatives, assigns, heirs, and next of kin of the undersigned or such participating children for any loss or damage, and any claim or demands on account of any property damage or any injury to, or an illness or the death of, the undersigned or such participating children (or any person who may contract COVID-19, directly or indirectly, from the undersigned or such participating children) whether caused by the negligence, active or passive, of X-Cel or otherwise while the undersigned or such participating children are in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with X-Cel. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS X-Cel, its directors, officers, employees, volunteers and agents owners , and each of them, from any loss, liability, damages or costs they may incur, whether caused by the negligence, active or passive, or otherwise while the undersigned or any participating child is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with X-Cel. The undersigned understands and agrees that upon entering the premises of X-Cel they have affirmatively and voluntarily assumed all risk for any potential injury that may occur as a direct or indirect result of the their presence and activities undertaken on the premises This waiver is intended to be as broad and inclusive as as permitted by the laws of the State of Ohio and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. The undersigned acknowledges that any illness or injuries that the undersigned or such participating children contract or sustain may be compounded by negligent first aid or emergency response of the Releasees and waive any claim in respect thereof.
Consent
I HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND WAIYER OF LIABILITY, AND INDEMNITY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE. I AM AWARE THAT BY AGREEING TO THIS AGREEMENT I AM GIVING UP VALUABLE LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES FROM X-CEL IN CASE OF ILLNESS, INJURY, DEATH OR PROPERTY DAMAGE, INCLUDING, FOR THE AVOIDANCE OF DOUBT AND WITHOUT LIMITATION, EXPOSURE TO COVID-19 AMYWHERE WHILE ON THE PREMISES AT XCEL OR WHILE ENGAGING IN ANY OFFERED PROGRAM AND ANY ILLNESS, INJURY OR DEATH RESULTING THEREFROM. I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDEMNIFICATION FOR ALL CLAIMS. IF SIGNING ON BEHALF OF MINOR: I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON BEHALF OF MY MINOR CHILD(REN) AND/OR LEGAL WARDS AND I REPRESENT AND WARRANT TO X-CEL THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S). I have read and understand the terms of this Assumption of Risk, Release and Waiver of Liability of the COVID-19 Addendum 2020-2021, and Indemnity Agreement and agree to its terms.
Parent/Guardian Signature*
Date*
MM slash DD slash YYYY
Emergency Contact Number*
Physician Name*
Physician Phone*
Email
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X-CEL ATHLETICS CHEER AND TUMBLE ACADEMY LLC, HOME OF STEP 1 ALLSTARS NORTH

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