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Free Learn to Row - Friday, June 1 & Saturday, June 2
Email address *
Participant Name *
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Participant Cell Phone Number *
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Participant Current Grade in School *
School Currently Attending *
Parent Name *
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Parent Email *
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Parent Cell Phone Number *
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Physician Name *
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Physician Contact Number *
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As the parent/guardian of the student/rower, I certify that he or she has been cleared by a physician for participation in sports within the last 12 months, is in good physical health and that strenuous exercise will in no way endanger his/her health (please discuss any medical conditions directly with the coach). *
I affirm that my student/rower can (1) tread water for at least 5 minutes and (2) swim 100 meters (any stroke) *
Release of Liability: IN CONSIDERATION of being given the opportunity to participate in any Walter Johnson Crew Club activity, including scheduled, supervised club activities, and registered regattas, during the policy term June 1 & 2, 2018, I, for myself, my personal representatives, assigns, heirs, and next of kin. 1. I ACKNOWLEDGE, agree and represent that I understand the nature of Rowing Activities, both on water and land based, and that I am qualified, in good health, and in proper physical condition to participate in such Activity. 2. I FULLY UNDERSTAND that: (a.) ROWING ACTIVITIES INVOLVE RISKS AND DANGERS of serious bodily injury, including permanent disability, paralysis and death (“Risks”); (b.) these Risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or the negligence of the Release named below; (c.) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the Activity. 3. I AGREE AND WARRANT that I will examine and inspect each Activity in which I take part as a member of Walter Johnson Crew Club and that, if I observe any condition which I consider to be unacceptably hazardous or dangerous, I will notify the proper authority in charge of the Activity and will refuse to take part in the Activity until the condition has been corrected to my satisfaction. 4. I HEREBY RELEASE, discharge, and covenant not to sue Walter Johnson Crew Club, the Club, the Regatta, their administrators, directors, agents, officers, volunteers and employees, other participating regatta organizers, any sponsors, advertisers, and if applicable, owners and lessors of premises, on which the Activity takes place, (each considered one of the Releases herein) from all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence of the Releasee or otherwise, including negligent rescue operations; and I further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement, I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as a result of such claim, to the fullest extent permitted by law. PLEASE DO NOT CHANGE OR ALTER THE WORDING ON THIS WAIVER WITHOUT PRIOR APPROVAL FROM WALTER JOHNSON CREW CLUB. I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect. *
Expected Participation *
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