AQUATIC WAIVER AND
RELEASE OF LIABILITY - Minor
“ Aquaknights Swim Club “
“ Dolphins Swim Club “ SeaWolves Swim Club
Participant’s
Name______________________________________ Phone___________________
Name
of Parent or Legal Guardian__________________________________________________
Address_______________________________________________________________________
City
____________________________________________________ State_____ Zip_________
Emergency
Phone Number (_____) ________________ Age ____________________________
We
the undersigned, certify that we are the parent or legal guardian of the above
named child, that he/she is in good physical condition and we, therefore, give
our permission for him/her to participate in the program marked above.
We
hereby acknowledge that the above named child has voluntarily applied to
participate in aquatic activities in conjunction with the above named team.
We
are 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. We 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, we understand
that there is a risk of injury to muscles, tendons, ligaments, joints, ankles,
knees, and legs while practicing and competing. We 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. We understand that in addition to
the above-mentioned risks, there are unpredictable dangers involved in this
sport. If, however, we observe any unusual and/or significant hazard we will
bring such to the attention of the nearest official immediately and remove the
above named child from participation if necessary.
In
consideration of the above named child’s participation in aquatic activities,
we 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 the above named child’s 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. We freely and voluntarily expressly assume all the risks of
participating in these aquatic activities.
We
also certify that the above named child is physically fit, has sufficiently
trained for participation in this aquatic activity and has not been advised
otherwise by a qualified medical person. We authorize you to call our family
physician in case of emergency.
We
understand that during practice and competition or related activities, the
above named child may be photographed. We agree to allow photo, video or film
likeness of the above named child to be used for any legitimate purpose by the
program officials, producers, sponsors, organizers and or assigns.
Lastly,
we agree to accept and abide by the rules and regulations of the team named
above and the City of
WE
HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND IT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT.
Signature
of Parent or Legal Guardian: ______________________________________________
Date:
_________________
Family
Doctor____________________________________________ Phone (___) ___________