Date *

MM

DD

YYYY

Name *

First Name

Last Name

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the Center for Disease Control (CDC) and many other public health authorities still recommend practicing the following precautionary measures, including, but not limited to, social distancing of at least six (6) feet apart, frequent hand-washing or hand-sanitizing, and wearing a face covering or mask over one's mouth and nose. *

Yes

I further acknowledge that The Charles Drew Memorial Scholarship Fund, Incorporated (CDMSF) has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19 during the tournament. *

Yes

I further acknowledge that CDMSF cannot and will not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, CDMSF members, facility staff and other guests at the facility. *

Yes

I voluntarily seek admission to this event and accept the risk to possible exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all procedures put in place to reduce the spread while attending this event. *

Select Event Below:

Yes

I agree to wear a face covering or mask covering the nose and mouth as recommended by the CDC in areas designated by the facility or when requested by a tournament coordinator. *

Yes

I further acknowledge that I will consent to a temperature upon arrival at the facility and will not be permitted to participate in the tournament if I have a temperature of 100.4 degrees or greater. *

Yes

With the acknowledgements noted above, I hereby release and agree to hold The CDMSF, The Omega Psi Phi Fraternity, Incorporated (OPP) and Gamma Pi Chapter harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of CDMSF, OPP and Gamma Pi Chapter, either in law or in equity, to the fullest extent permissible by law or that may otherwise arise in any way in connection with any invitation received from OPP and THE GAMMA PI CHAPTER. I understand that this release discharges CDMSF, OPP and Gamma Pi Chapter from any liability or claim that I, my heirs, or any personal representatives may have against CDMSF, OPP and Gamma Pi Chapter with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any invitation received from CDMSF, OPP and Gamma Pi Chapter. This liability waiver and release extends to CDMSF, OPP and Gamma Pi Chapter together with all owners, partners, and employees, directors, officers, members and volunteers. *

PLEASE PROVIDE YOUR ELECTRONIC SIGNATURE BELOW

First Name

Last Name