COVID-19 Training & Waiver Step 1 of 11 9% This waiver should be completed by the participant if they are their own guardian. If the participant is a minor or is not their own guardian, then this waiver should be completed by the parent/guardian for the participant (please enter the participant's name at the end). Please understand that you could get Coronavirus (COVID-19) through sports, training, competition, and/or any group activity at Special Olympics. You choose to participate in sports, competition, and/or other Special Olympics Minnesota activities at your own risk. Who is at higher risk of COVID-19? COVID-19 is a relatively new disease and information is changing on who is more likely to get COVID-19 and who will have more complications. Based on currently available information and clinical expertise, people with intellectual and developmental disabilities may be at higher risk of severe illness resulting in death from COVID-19. Current clinical guidance and information from the U.S. CDC lists those at high risk for severe illness from COVID-19 as unvaccinated people 60 years and older (risk increases with age) and unvaccinated people with disabilities. Regardless of age, individuals who are unvaccinated and have underlying conditions on the next page are or may be at increased risk of severe illness from COVID-19. Risk assessmentPlease check YES if any of the following apply to you (or your child/ward if you are a parent/guardian filling this out for someone else).I am 65 years old or older.* Yes No I live in a nursing home, group home or long-term care facility.*for example, a congregate or group home Yes No I have chronic lung disease or moderate to severe asthma.* Yes No I have a serious heart condition.*including heart failure, heart surgery, coronary artery disease, congenital heart disease, cardiomyopathy Yes No I am currently immunocompromised.*Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications. Yes No I am considered obese (body mass index [BMI] of 30 or higher).*Calculate your BMI Yes No I have diabetes.* Yes No I have chronic kidney disease and am undergoing dialysis.* Yes No I have liver disease.* Yes No I have a brain disorder and/or spinal cord disorder.*e.g., cerebral palsy, epilepsy, stroke, dementia Yes No Based on your responses to the previous questions, if you are unvaccinated you are considered to be at HIGH RISK to contract and/or experience worse symptoms of COVID-19.Based on your responses to the previous questions, you are NOT considered high risk to contract and/or experience worse symptoms of COVID-19.If you are at a high risk and unvaccinated, you may be putting yourself at risk when you return to activities with Special Olympics Minnesota. But you may also put at risk your family and your teammates. If you have any of these conditions and are unvaccinated, it is recommended that you do not return to Special Olympics Minnesota in-person activities until you are vaccinated or the community transmission in your community is low. If you do choose to return to in-person activities, you acknowledge the risks that are associated with these activities, which includes putting yourself and your teammates and family at risk. If you have been diagnosed with COVID-19, you should consult with a healthcare professional for written medical clearance before returning to Special Olympics Minnesota in person activities as serious cardiac, respiratory, and neurological issues may develop as a result of COVID-19.Risk agreement* I acknowledge that I may be putting myself at risk as well as my teammates and family by returning to in-person activities with Special Olympics Minnesota. Regardless of your risk level, please complete the remaining sections of this form and submit it online. TrainingWhat is Coronavirus? Coronavirus COVID-19 is a lung illness that can spread from person to person. The virus that causes COVID-19 is a new coronavirus that was first discovered in Wuhan, China. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. What are the symptoms of COVID-19? People with the coronavirus have mild to severe illness with symptoms of: Fever (100.4 F/ 37.8 C or higher) Cough Shortness of breath Most people with COVID-19 will have a mild illness, but some people will get sicker and may need to be hospitalized. If you are an older adult, are pregnant or have chronic health conditions, contact your physician’s office so that they can monitor your health more closely or test you for COVID-19. If you have a fever, cough or shortness of breath and you suspect you might have been exposed to COVID-19, you should: Call your healthcare provider. They can help you decide if you need to be evaluated in person. If you believe it's a medical emergency, call 911 and notify the dispatch personnel that you may have been exposed to COVID-19. What should I do if I have been in close contact with someone with COVID-19 but I am not sick? Monitor your health for fever, cough and shortness of breath for 14 days from your last close contact with the person who has COVID-19. Do not go to work or school, and avoid public places for 14 days. How does COVID-19 spread? Coughing or sneezing in close personal contact Shaking hands Touching your eyes, mouth, or nose after touching an object or surface an infected person also touched How can I protect myself? Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available. Avoid touching your eyes, nose, and mouth with unwashed hands. Avoid close contact with people who are sick. This generally means staying 6 feet (or about 2 meters) away. Stay home when you are sick. Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. Cover your cough or sneeze with a tissue, then throw the tissue in the trash. Handwashing steps COVID-19 screening protocol and checklist Delegations may need to screen participants when Special Olympics Minnesota is in a COVID-19 restrictive phase. The screening will ask the following questions before practice (reinforced both verbally and visually, such as with a poster or paper with icons): Have you ever tested positive for COVID-19? If yes, what date(s) did you test positive?In the last 14 days, have you had contact with someone who has been sick with COVID-19? Have you had a fever in the last week (temperature of 100.4°F/37.8°C or higher)? Do you have a cough and/or difficulty breathing? Do you have any other signs or symptoms of COVID-19 (fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea)? If screening is required, the delegation must conduct on-site measurement of temperature using thermometer (preferably a non-touch thermal scanning thermometer). A fever is a temperature of 100.4°F/37.8°C or higher. If high, may re-test after 5 minutes to ensure temperature is accurate. If screening is required, the delegation must record all names, results and contact information for each person and keep in case needed for contact tracing or reporting. If YES to any questions, participants MUST be isolated from the group (at minimum, kept 6 feet/2 meters apart from others and with mask on), sent home, and instructed to contact their healthcare provider for evaluation. Participants who are found to have COVID-19 symptoms and have not tested positive must wait 7 days after symptoms resolve to return to activity OR must provide written proof of physician clearance to Special Olympics Minnesota to return earlier. Participants who have at any time tested positive for or currently have COVID-19 must provide written medical clearance before returning to sport and fitness activities. WaiverDuring the time these precautions are needed, I agree to the following to help keep me and my fellow participants safe. Please read and check every box.If I have COVID-19 symptoms* If I have COVID-19 symptoms, I will stay at home and NOT go to any activities until 7 days after all of my symptoms are over. If I am exposed to COVID-19 and have no symptoms, I must self-quarantine if required by local regulations. If I get or have had COVID-19* If I get or have had COVID-19, I will not go to any in-person Special Olympics Minnesota events until 7 days after my symptoms end. I will go to my doctor and get written clearance before returning to any sport or fitness activities. Special Olympics Minnesota gave me education* Special Olympics Minnesota gave me education on Special Olympics rules for COVID-19 and who is at high-risk. If I have a high-risk condition* I know that if I have a high-risk condition, I have more risk that I could get sick or die from COVID-19. If I have a high-risk condition and am not fully vaccinated, I should not go to Special Olympics Minnesota events in person, until there is little or no Coronavirus in my community. Before or when I get to a Special Olympics Minnesota activity* I know that before or when I get to a Special Olympics Minnesota activity, they may ask me some questions about symptoms and exposure to COVID-19. They will also take my temperature. I will answer truthfully and participate fully. I will keep at least 6 feet (2 meters) away* I will keep at least 6 feet (2 meters) away from all participants when asked. I will wear a mask at all times* I will wear a mask at all times while at Special Olympics Minnesota activities when asked. I may not have to wear it during active exercise. I will wash my hands for 20 seconds* I will wash my hands for 20 seconds or use hand sanitizer before any activities. I will wash my hands any time I sneeze, cough, go to the bathroom or get my hands dirty. I will avoid touching my face* I will avoid touching my face. I will cover my mouth when I cough or sneeze and immediately wash my hands after. I will not share drinking bottles* I will not share drinking bottles or towels with other people. I will only share equipment when instructed to* I will only share equipment when instructed to. If equipment must be shared, I will only touch the equipment if it is disinfected first. I understand that if I do not follow all of these rules* I understand that if I do not follow all of these rules, I will not be allowed to participate in Special Olympics Minnesota activities during this time. Participant confirmationI have read all of this agreement* I have read all of this agreement or have had it read to me and agree to follow these actions. Participant name* First Last Phone number*Phone type*CellHomeWorkOtherEmail address* Role*AthleteUnified partnerCoachYoung AthleteYoung PartnerVolunteerFamily member/caregiverSOMN staffor the role of the participant you are completing this for as a parent/guardianDelegation* Parent or guardian confirmationThis information is required for all participants who are under age 18 OR who are not their own guardians.I am a parent or guardian of the athlete/participant I am a parent or guardian of the athlete/participant named above. I have read and understand this form and have explained the contents to the participant as appropriate. By submitting this form, I agree to this agreement on my own behalf and on behalf of the participant. Parent or guardian name First Last Relationship to participant Parent/guardian email addressif different than the email address already entered at the beginning of the form Parent/guardian phone numberPhone type*CellHomeWorkOtherBy clicking the SUBMIT button, I acknowledge that I have completely read and fully understand the information in this agreement.
