WAIVER/RELEASE OF LIABILITY

 

 

PLEASE READ CAREFULLY BEFORE SIGNING.
THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS.


I, ____________________________________________________, the enrolled participant and/or the parent/guardian of the participant agree and understand that swimming is a HAZARDOUS activity. I recognize that there are risks inherent in the sport of swimming, including but not limited to paralyzing injuries and death.

The participant hereby agrees to participate in the Rappahannock Swim League program and hereby agrees to indemnify and hold harmless the Rappahannock Swim League, Inc., its coaches, officers, directors, agents, volunteers and employees, and its swim teams and their respective coaches, officers, directors, agents, volunteers and employees against any liability resulting from an injury that may occur to the participant while participating in the Rappahannock Swim League program. The participant also agrees to indemnify the Rappahannock Swim League, Inc. and the Hampton Oaks Swim Team for any damages incurred arising from any claims, demand, action or cause of action by the participant.

The participant authorizes any representative of the Rappahannock Swim League, Inc. or the Hampton Oaks Swim Team to have the participant treated in any medical emergency during their participation in the Rappahannock Swim League program. Further, the participant and/or the parent/guardian agree to pay all costs associated with medical care and transportation for the participant.

I have noted on the back of this form any medical/health problems of which the staff should be aware.

I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.




Signed: ___________________________________________Date:________________
(Participant) 



Signed:_______________________________________Date:_______________
(Parent/Guardian) 

 

 

 

Registration Form

Parent’s Name: _____________________________________________________

Street Address: ______________________________________________________

Telephone (H): ____________________ 
Emergency Contact: _________________________________ (name and phone number)
(Someone other than Parent)

Father’s Work Phone: ___________________
Mother’s Work Phone: __________________

Parent’s E-Mail: __________________________________

Other E-Mail: ____________________________________

Swimmers:
FEE
Name: _______________________DOB: ____________ $__________

Name: _______________________DOB: ____________ $__________

Name: _______________________DOB: ____________ $__________

Name: _______________________DOB: ____________ $__________

Concessions Fee $ 20.00
TOTAL $__________

HOST Season Fee: first child = $65.00, second child = $55.00, third child = $45.00, fourth child is free. 
Family Fee Cap = $165.00 Basic Swimmer Fee + Family Concessions Fee of $20.00 = $185.00 total

I understand that I will be required to volunteer for each home meet in which my child(ren) participate(s) as well as 2 away meets. Further, I understand that I must volunteer to support the Division Finals if my child(ren) participates.


Signed:__________________________________________Date:___________
(Parent/Guardian)


Please bring to registration on April 6, 2006 or return to Pattie Batt, 659-1324, batt232@adelphia.net, at 29 Brittany Lane along with Waiver/Release of Liability form.

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