*

I am in good health and have no physical conditions that affect my ability to participate in the Event and have not been advised otherwise by a medical practitioner.

I have not been in close contact with a person proven or believed to have a COVID-19 infection. I have not traveled outside the United States in the past 14 days.

I have not been diagnosed positive for COVID-19 virus at any time (or if I have, I have been cleared by medical doctors as no longer contagious) and am not awaiting results of a COVID19 test. I am not experiencing symptoms of COVID-19 infection, such as fever, shortness of breath, cough, loss of taste or smell, muscle pain, vomiting, diarrhea, or headache in the last 48 hours.

I am covered by medical insurance, individually or as part of an organization.

I understand that during the event I will be working with others and will be handling debris of unknown origin.

I agree that before I participate in any portion of the Event, I will inspect the related facilities, site, and equipment.

I will immediately advise Event personnel of any unsafe condition that I observe.

I will refuse to participate in the Event until all unsafe conditions have been remedied.

I will abide by any safety guidelines made available to me.

I assume full responsibility for all risks associated with my participation in the Event and the risk of injury or damage caused by the condition of any property, facilities, or equipment used during the Event, which may not be foreseeable by anyone at any time. I assume full responsibility for any disease I suffer as a result of exposure to the novel coronavirus or any other virus or bacteria during the event.

Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country