Player Information: *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Uniform Sizes *

Adult

Youth

Sizes

XS

S

M

L

XL

2XL

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Name *

First Name

Last Name

Phone *

(###)

###

####

Water Fitness (Assumption of Risk: I, the guardian, grant permission for my child (named above) to use the Boys and Girls Club Swimming Pool; I recognize and understand that using the Swimming Pool involves certain risks. Those risks include, but are not limited to, the risk of injury resulting from possible malfunction of the equipment used in the pool and injuries resulting from tripping or falling over obstacles in the pool area.) *

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT In consideration of participating in the “SWIM”, I hereby agree as follows: 1. TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against BOYS & GIRLS CLUB FAMILY CENTER, their directors, officers, employees, agents and representatives (all of whom are hereinafter referred to as “the Releases”); 2. TO RELEASE THE RELEASES from any and all liability for any loss, damage, injury, or expense that I may suffer or that my next of kin may suffer as a result of my participation at the Swimming Pool due to any cause whatsoever, INCLUDING NEGLIGENCE ON THE PART OF THE RELEASES; 3. TO HOLD HARMLESS AND INDEMNIFY THE RELEASES from any and all liability from any damage to property of, or personal injury to, any third party, resulting from my participation at the Swimming Pool; 4. That this Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators and assigns, in the event of my death.

YES - I HAVE READ AND UNDERSTOOD THIS AGREEMENT, AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS, WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASES.

NO - I DO NOT GRANT PERMISSION