PASO AQUATIC CLUB AT KENNEDY

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* Swimmer First Name:

* Swimmer Middle Name:

* Swimmer Last Name:

* Swimmer Birthdate:

* Guardian First and Last Name:

* Email:

* Mailing Address:

* City, State:

* Zip Code:

* Phone:

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* Emergency Contact Information (other than guardian):

As the enrolled participant and/or guardian of the participant, I agree and understand that swimming is a HAZARDOUS activity. I hereby agree to participate in Paso Aquatic Club and hereby agree to indemnify and hold harmless Paso Aquatic Club, its coaches, officers, directors, agents, and employees against any liability resulting from any injury that may occur to participant while participating in Paso Aquatic Club. The participant and/or guardian of the participant also agrees to indemnify Paso Aquatic Club for any damages incurred arising from any claims, demand, action, or cause of action by the participant. The participant and/or guardian of the participant authorizes any representative of Paso Aquatic Club to have the participant treated in any medical emergency during their participation in Paso Aquatic Club. Further, the participant and/or guardian of the participant agrees to pay all cost associated with medical care and transportation for the participant. I have noted below any medical/health problems of which the staff should be aware. I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND AGREE TO IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.

Please check to indicate that you accept the terms of the waiver *

Please list any medical/health or other conditions our staff should be aware of:

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Date:

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