EXIT TURKEY MOUNTAIN LIABILITY AND WAIVER FORM Question Title * 1. YOUR NAME OK Question Title * 2. ADDRESS Address City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number OK Question Title * 3. LIST ANY CHILDREN YOU WILL BE SUPERVISING TONIGHT OK Question Title * 4. PLEASE CAREFULLY READ THE WAIVER & RELEASE OF LIABILITYBy my digital/virtual signature below, I confirm my understanding of the following concerning my voluntary participation in today’s event. I choose to participate in this activity at my own risk and I will abide by any and all instructions provided to participants to help assure my own safety and that of my participating family members, if applicable. I agree to assume all risks associated with my participation in this activity and I indemnify and hold harmless the River Parks Authority, the City of Tulsa, Tulsa County, WSA Soccer, Tulsa Field Sports Alliance, and their respective officers, directors, employees, contractors, volunteers, and/or agents for any claims for personal injury or property damage resulting from or in any way connected with my participation in today’s activity.I have read and understand and accept the terms and conditions outlined above on my behalf and on behalf of my entire party and any children I am supervising during the event. I UNDERSTAND and AGREE OK Question Title * 5. BY TYPING YOUR NAME BELOW YOU OFFER YOUR DIGITAL SIGNATURE AS AN UNDERSTANDING OF THESE TERMS FOR YOUR PARTICIPATION (and your children's participation under your supervision). OK COVID19 QUESTIONS OK Question Title * 6. TODAY'S DATE & TIME Date / Time Date Time AM/PM - AM PM OK Question Title * 7. COVID Q1: Are you experiencing symptoms consistent with COVID-19 including fever of 100.4 degrees or higher or chills, persistent cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, nausea or vomitting, diarrhea, or loss of taste/smell? Yes No OK Question Title * 8. COVID Q2: Without social distancing or wearing a mask, have you been within six feet of a sick person with COVID-19 for 15 minutes or more in the past 14 days and/or are you actively caring for a person sick with COVID19? Yes No OK SUBMIT
