Kick It Up

Kick It Up Covid Questionnaire

& Contact Tracing Form

Please Answer ALL Questions
Question #1   Are you experiencing any symptoms?  Symptoms include: a new or worsening cough, shortness of breath or difficulty breathing, temperature equal to or over 38°C, feeling feverish, chills, fatigue or weakness, muscle or body aches, headache, new loss of smell or taste, gastrointestinal symptoms (abdominal pain, diarrhea, vomiting), feeling very unwell *
Question #2   Has anyone in your household experienced any symptoms in the past 14 days? (Note: if the symptomatic person in your household has received a negative COVID-19 test result, please answer 'no') *
Question #3   In the past 14 days, have you been identified as a close contact of someone with suspected or confirmed COVID-19? *
Question #4   Have you travelled outside Canada in the past 14 days or been in contact with anyone who has travelled outside Canada in the past 14 days? *
Question #5   Have you or the person you came in contact with completed the manditory testing and quarenteening required by the Canadian government? *
Have you experienced any symptoms since you were last at the facility? *
Has it been at least 10 days since your symptoms started? *
Have you been symptom free for at least 48 hours? *
Please select ALL that apply
SORRY BUT YOU
MAY NOT ENTER THE FACILITY
Congratulations
Please Read Below &
Sign to be allowed in the facility
1. This is a binding legal agreement. Clarify any questions or concerns before signing. As a Participant in
activities, filming, programs, classes, services provided sponsored or organized by 1473373 Ontario Limited o/a Kick It Up Dance Competition (collectively the “Organization”)  including but not limited
to: dance, rehersal of dance, filming of dances (collectively the “Activities”), the undersigned being the Participant, Participant’s Parent/Guardian, Teacher, Director of a studio (collectively the “Parties”) acknowledges and agrees to the following terms outlined in this agreement:
2. I am the Parent/Guardian of a, or the Participant and have full legal responsibility for the decisions of the Participant or I am 18 years of age or older if filling this form out for myself or am a Teacher or Studio Director of the participating studio.
Description of Risks
3. The Parties understand and acknowledge that:
    a) The Activities have foreseeable and unforeseeable inherent risks, hazards and dangers that no amount of care, caution or expertise can eliminate, including without limitation, the potential for serious bodily injury, permanent disability, paralysis and loss of life;
    b)The Organization has a difficult task to ensure safety and it is not infallible. The Organization may be unaware of the Parties fitness or abilities, may give incomplete warnings or instructions, may misjudge weather or environmental conditions, and the equipment being used might malfunction; and
    c) The novel coronavirus, 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; however, the Organization cannot guarantee that the Parties will not become infected with COVID-19. Further, attending the Activities could increase your risk of contracting COVID-19.
4. The Parties are participating voluntarily in the Activities. In consideration of that participation, the Parties hereby acknowledge that they are aware of the risks, dangers and hazards and may be exposed to such risks, dangers and hazards. The risks, dangers and hazards include, but are not limited to:
    a) Contracting COVID-19 or any other contagious disease;
    b) Executing strenuous and demanding physical techniques;
    c) Vigorous physical exertion, strenuous cardiovascular workouts and rapid movements;
    d) Exerting and stretching various muscle groups;
    e) The failure to properly use any piece of equipment or from the mechanical failure of any piece of
equipment;
    f) Spinal cord injuries which may render the Participant permanently paralyzed;
    g) Serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the Parties body or to the Parties general health and well-being;
    h) Abrasions, sprains, strains, fractures, or dislocations;
    i) Concussion or other head injuries, including but not limited to, closed head injury or blunt head trauma;
    j) Physical contact with other Parties, equipment, and hazards;
    k) Not wearing appropriate safety or protective equipment;
    l) Failure to act safely or within the Parties ability or within designated areas;
    m) Negligence of other persons, including other Parties, or employees;

Terms
5. In consideration of the Organization allowing the Parties to participate in the Activities, the Parties agree:
    a) That the Parties mental and physical condition is appropriate to participate in the Activities;
    b) To comply with the terms of use, rules and regulations for participation in the Activities set forth on 1473373 Ontario Limited o/a Kick It Up Dance Competition website Rules and Regulations | kickitup
    c)  To comply with the rules of the facility;
    d) That if the Parties observes an unusual significant hazard or risk, the Parties will remove themselves from participation and bring such to the attention of an Organization representative immediately;
    e) The risks associated with the Activities are increased when the Parties are impaired and the Parties agree not to participate if impaired in any way;
    f) That it is their sole responsibility to assess whether any Activities are too difficult for the Parties. By the Parties commencing an Activity, they acknowledge and accept the suitability and conditions of the Activity;
    g) That they are responsible for the choice of the Parties protective equipment and the secure fitting of the protective equipment;
    h) That COVID-19 is contagious in nature and the Parties may be exposed to or infected by COVID-19 and such exposure may result in personal injury, illness, permanent disability or death and voluntarily agree to assume all of the foregoing risks.
 
General
6. The Parties expressly agree that this Agreement is intended to be as broad and inclusive as is permitted by law and that if any of its provisions are held to be invalid, the balance shall, notwithstanding, continue in full legal force and effect.
 
Acknowledgement
7. The Parties acknowledge that they have read this agreement and understand it, that they have executed this agreement voluntarily, and that this Agreement is to be binding upon themselves, their heirs, their spouses, parents, guardians, next of kin, executors, administrators and legal or personal representatives.
8.Upon entering 1473373 Ontario Limited o/a Kick It Up Dance Competition facility, it is agreed that teachers, competitors, parents, will not hold 1473373 Ontario Limited o/a Kick It Up Dance Competition, 1473373 Ontario Limited o/a Kick It Up Dance Competition's directors, employees, the host facility and all involved in the filming of dances responsible or liable for any damages, loss or personal injury which they may sustain while participating in any activity connected with this private youth sports day, no matter how caused, to any of the Parties. Parties participate at their own risk.
Crew
1. This is a binding legal agreement. Clarify any questions or concerns before signing. As a Crew member of 1473373 Ontario Limited o/a Kick It Up Dance Competition or owner, employee of 1473373 Ontario Limited o/a Kick It Up Dance Competition's client in activities, filming, services provided sponsored or organized by 1473373 Ontario Limited o/a Kick It Up Dance Competition (collectively the “Organization”)  including but not limited to: filming of dances, cleaning, sign in table duties, music table, COVID Police, backstage manager (collectively the “Activities”), the undersigned being Crew of 1473373 Ontario Limited o/a Kick It Up Dance Competition , employee, director or owner of 1473373 Ontario Limited o/a Kick It Up Dance Competition's client, (collectively the “Parties”) acknowledges and agrees to the following terms outlined in this agreement:
2. I am the Parent/Guardian of a Crew member and have full legal responsibility for the decisions of the Crew member or I am 18 years of age or older if filling this form out for myself.
Description of Risks
3. The Parties understand and acknowledge that:
    a) The Activities have foreseeable and unforeseeable inherent risks, hazards and dangers that no amount of care, caution or expertise can eliminate, including without limitation, the potential for serious bodily injury, permanent disability, paralysis and loss of life;
    b)The Organization has a difficult task to ensure safety and it is not infallible. The Organization may be unaware of the Parties fitness or abilities, may give incomplete warnings or instructions, may misjudge weather or environmental conditions, and the equipment being used might malfunction; and
    c) The novel coronavirus, 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; however, the Organization cannot guarantee that the Parties will not become infected with COVID-19. Further, attending the Activities could increase your risk of contracting COVID-19.
4. The Parties participating in the Activities are doing so of their own free will. In consideration of that participation, the Parties hereby acknowledge that they are aware of the risks, dangers and hazards and may be exposed to such risks, dangers and hazards. The risks, dangers and hazards include, but are not limited to:
    a) Contracting COVID-19 or any other contagious disease;
    b) Executing strenuous and demanding physical techniques;
    c) Vigorous physical exertion, strenuous cardiovascular workouts and rapid movements;
    d) Exerting and stretching various muscle groups;
    e) The failure to properly use any piece of equipment or from the mechanical failure of any piece of
equipment;
    f) Spinal cord injuries which may render the Participant permanently paralyzed;
    g) Serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the Parties body or to the Parties general health and well-being;
    h) Abrasions, sprains, strains, fractures, or dislocations;
    i) Concussion or other head injuries, including but not limited to, closed head injury or blunt head trauma;
    j) Physical contact with other Parties, equipment, and hazards;
    k) Not wearing appropriate safety or protective equipment;
    l) Failure to act safely or within the Parties ability or within designated areas;
    m) Negligence of other persons, including other Parties, or employees;

 
Terms
5. In consideration of the Organization allowing the Parties to participate in the Activities, the Parties agree:
    a) That the Parties mental and physical condition is appropriate to participate in the Activities;
    b) To comply with the terms of use, rules and regulations for participation in the Activities set forth on 1473373 Ontario Limited o/a Kick It Up Dance Competition website Rules and Regulations | kickitup
    c)  To comply with the rules of the facility;
    d) That if the Parties observes an unusual significant hazard or risk, the Parties will remove themselves from participation and bring such to the attention of an Organization representative immediately;
    e) The risks associated with the Activities are increased when the Parties are impaired and the Parties agree not to participate if impaired in any way;
    f) That it is their sole responsibility to assess whether any Activities are too difficult for the Parties. By the Parties commencing an Activity, they acknowledge and accept the suitability and conditions of the Activity;
    g) That they are responsible for the choice of the Parties protective equipment and the secure fitting of the protective equipment;
    h) That COVID-19 is contagious in nature and the Parties may be exposed to or infected by COVID-19 and such exposure may result in personal injury, illness, permanent disability or death and voluntarily agree to assume all of the foregoing risks.
 
General
6. The Parties expressly agree that this Agreement is intended to be as broad and inclusive as is permitted by law and that if any of its provisions are held to be invalid, the balance shall, notwithstanding, continue in full legal force and effect.
 
Acknowledgement
7. The Parties acknowledge that they have read this agreement and understand it, that they have executed this agreement voluntarily, and that this Agreement is to be binding upon themselves, their heirs, their spouses, parents, guardians, next of kin, executors, administrators and legal or personal representatives.
8.Upon entering, it is agreed that Crew members of 1473373 Ontario Limited o/a Kick It Up Dance Competition or owner, employee of 1473373 Ontario Limited o/a Kick It Up Dance Competition's client will not hold 1473373 Ontario Limited o/a Kick It Up Dance Competition, 1473373 Ontario Limited o/a Kick It Up Dance Competition's directors, employees, the host facility and all involved in the filming of dances responsible or liable for any damages, loss or personal injury which they may sustain while participating in any activity connected with this private youth sports day, no matter how caused, to any of the Parties. Parties participate at their own risk.
Please sign with your mouse here *
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