Atlantic City Aquatic Club

 

ACCIDENT WAIVER OF LIABILITY, INDEMNITY AGREEMENT

AND CERTIFICATION AND RELEASE FOR

[EMERGENCY MEDICAL TREATMENT]

 

I, _________________________________, the enrolled participant and/or the parent/legal guardian of the participant agree and understand that swimming is a HAZARDOUS activity.  I recognize that there are risk and inherent in the sport of swimming, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from the Greater South Jersey Swim League 2008 Summer Championships given by Atlantic City Aquatic Club.

 

I certify that the enrolled participants are physically fit, have sufficiently prepared or trained for participation in the activity or event (Greater South Jersey Swim League 2008 Summer Championships given by Atlantic City Aquatic Club), and have not been advised to not participate b a qualified medical professional.

 

I acknowledge that this Accident waiver of liability, indemnity agreement and certification and release form will be used by the event holders, Atlantic City Aquatic Club, Atlantic City Board of Education, the City of Atlantic City and Recreation Department, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event.

 

In consideration of the signed waiver and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, and successors.

 

(A)     I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to,

liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from the Greater South Jersey Swim League 2008 Summer Championships given by Atlantic City Aquatic Club.  THE FOLLOWING ENTITIES OR PERSONS: Atlantic City Aquatic Club, Atlantic City Board of Education, the City of Atlantic City and Recreation Department, board directors, officers, employees, volunteers, representatives, and agents, the activity or event sponsors, the activity or event holders, activity or event, whether caused by the negligence of release or otherwise.

 

(B)     I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this

release from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by negligence of release or otherwise.

 

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event.  Further, the participant and/or parent/guardian agree to pay all costs associated with medical care and transportation for the participant.

 

I understand that at this event or related activities, I may be photographed.  I agree to allow my photo, video, or film likeness to be used for nay legitimate purpose by the event holders, producers, sponsors, organizers, and assigns.

 

The wavier and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

 

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT.  I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

 

 

_____________________________________                      ________        ______________________________            _________

Print Participant’s Name                                                                      Age                        Signature (if under 18 years old,                       Date

                                                                                                                                                Parent or guardian must also sign)

 

 

____________________________________________                        ___________________________________________________________________

Team                                                                                                      Address and Phone number of Participant’s (Print)