3 - Facility Declaration 20200529.docx
Participant Name (print): ___________________________________________________
Participant’s Parent/Guardian ___________________________________________________
(if the participant is younger than the age of majority)
Email: ___________________________________________________
Phone: ___________________________________________________
Gymnastics Ontario and its affiliated clubs (collectively the “Organization”) require the disclosure of
exposure or illness is in order to safeguard the health and safety of all participants and limit the further
spread of COVID-19. This Declaration of Compliance will be kept safely, and personal information will
not be disclosed unless as required by law or with your consent.
A participant (or the participant’s parent/guardian, if the participant is younger than the age of majority)
who is unable to agree to the terms outlined in this document is not permitted to enter the
Organizations facilities or participate in the Organization’s activities, programs, or services.
I, the undersigned being the participant named above and the participant’s parent/guardian (if the
participant is younger than the age of majority), hereby acknowledge and agree to the terms outlined in
this document:
1) The coronavirus disease COVID-19 has been declared a worldwide pandemic by the World Health
Organization and COVID-19 is extremely contagious. The Organization has put in place preventative
measures to reduce the spread of COVID-19 and requires all participants (or their parent/guardian,
when applicable) to adhere to the compliance standards described in this document.
2) The participant has not been diagnosed with COVID-19. OR If the participant was diagnosed with
COVID-19, the participant was cleared as noncontagious by provincial or local public health
3) If the participant is a front-line worker (such as hospital staff, long term care staff, or other
individual who interacts with individuals who have confirmed or suspected cases of COVID-19) or
required to travel outside of Canada, the participant has worn proper and approved Personal
Protective Equipment at all times whenever they interacted with an individual who has a confirmed
or suspected case of COVID-19 in the last 14 days.
4) If the participant is not a front-line worker or travelled outside of Canada, they have not been
exposed to a person with a confirmed or suspected case of COVID-19 in the last 14 days.
3 - Facility Declaration 20200529.docx
5) The participant is attending or participating voluntarily and understands the risks associated with
COVID-19. The participant (or the participant’s parent/guardian, on behalf of the participant (when
applicable) agrees to assume those risks, including but not limited to exposure and being infected.
6) The participant has not, nor has anyone in the participant’s household, experienced any signs or
symptoms of COVID-19 in the last 14 days (including fever, new or worsening cough, fatigue, chills
and body aches, respiratory illness, difficulty breathing, nausea, vomiting or diarrhea, pink eye, or
loss of taste or smell).
7) If the participant experiences, or if anyone in the participant’s household experiences, any signs or
symptoms of COVID-19 after submitting this Declaration of Compliance, the participant will
immediately isolate, notify the Organization, and not attend any of the Organization’s facilities,
activities, programs or services until at least 14 days have passed since those symptoms were last
8) The participant is following recommended guidelines, including but not limited to, practicing
physical distancing, trying to maintain separation of six feet from others, adhering to recognized
hygiene best practices, and otherwise limiting exposure to COVID-19.
9) The participant will follow the safety, physical distancing, and hygiene protocols of the Organization.
10) This document will remain in effect until the Organization, per the direction of the provincial
government and provincial health officials, determines that the acknowledgements in this
Declaration of Compliance are no longer required.
11) The Organization may remove the participant from the facility or from participation in the activities,
programs or services of the Organization at any time and for any reason if the Organization believes,
in its sole discretion, that the participant is no longer in compliance with any of the standards
described in this document.
Signature: _____________________________________ Date: ___________________
Participant (If the age of majority)
Signature: _____________________________________ Date: ___________________
Parent/Guardian (if the participant is younger than the age of majority)