AQUATIC WAIVER AND RELEASE OF LIABILITY -
Adult
“ Aquaknights Swim Club “
“ Dolphins Swim Club “ SeaWolves Swim Club
Participant’s
Name______________________________________ Phone___________________
Address_______________________________________________________________________
City
____________________________________________________ State_____ Zip_________
Emergency Phone Number (_____)
________________ Age ____________________________
I the undersigned, certify that I am in
good physical condition and wish to participate in the program marked above.
I hereby acknowledge that I have
voluntarily applied to participate in aquatic activities in conjunction with
the above named team.
I am aware that serious accidents occasionally
occur during aquatic activities; and that participants occasionally sustain
serious personal injury or death and/or property damage, as a consequence
thereof. I understand that included
among the dangerous elements of aquatic activities are risks associated with
weather, water conditions, including temperature, currents, waves and
pollution, of injury as a result of being struck by another swimmer/diver or
his/her equipment. Additionally, I
understand that there is a risk of injury to muscles, tendons, ligaments,
joints, ankles, knees, and legs while practicing and competing. I understand
that the pool deck, bottom, sides, diving boards and starting blocks cannot be
guaranteed to be smooth or free of defects, and that there is the risk of
injury as a result of tripping or striking an unknown object. I understand that
in addition to the above-mentioned risks, there are unpredictable dangers
involved in this sport. If, however, I observe any unusual and/or significant
hazard I will bring such to the attention of the nearest official immediately
and remove myself from participation if necessary.
In consideration of my participation in
aquatic activities, I voluntarily release the team indicated above, the City of
Brentwood and/or its officers, agents,
employees and volunteers from any and all liability for injuries or death, or
property damage resulting from or in any way connected with my participation in
aquatic activities, that this waiver and release is applicable even though the
negligent activities of team named above, the City of Brentwood, and/or its officers,
agents, employees or volunteers may have caused or contributed to the injury or
death or property damage, and this document is binding on my heirs and
dependents as well as myself. I freely and voluntarily expressly assume all the
risks of participating in these aquatic activities.
I also certify that I am physically fit,
have sufficiently trained for participation in this aquatic activity and have
not been advised otherwise by a qualified medical person. I authorize you to
call my family physician in case of emergency.
I understand that during practice and
competition or related activities, I may be photographed. I agree to allow
photo, video or film likeness of me to be used for any legitimate purpose by
the program officials, producers, sponsors, organizers and or assigns.
Lastly, I agree to accept and abide by
the rules and regulations of the team named above and the City of
I HAVE READ THIS RELEASE OF LIABILITY AND
ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND IT AND SIGN IT FREELY AND
VOLUNTARILY WITHOUT INDUCEMENT.
Signature
______________________________________________ Date: ___________________
Family
Doctor ___________________________________________ Phone (___) ____________