WMAC Adult Learn to Swim Registration Form
Full Name *
Email *
Mailing Address *
City *
State *
Zip Code *
Phone Number *
Male or Female
Are you a senior (over 65)? *
Health Information *
Please list any conditions, chronic illness, allergies, special needs, etc.
Liability and Waiver Release
Liability Release, Assumption of Risk, Indemnification, Parental Consent Agreement, and Media Release
In signing this agreement, the participant agrees to abide by the conditions herein. I consent to my or my minor’s participation in the lessons, programs, classes, events or other uses (hereinafter “Activities”) offered by White Mountain Aquatic Center (WMAC) and its staff at the WMAC’s facilities and at other swimming pools, bodies of water or facilities. I acknowledge that I fully understand my or my minor’ s participation may involve risk of serious injury or death, including losses which may result not only from my or my minor’ s own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the Activities are conducted, and the rules of play for these Activities. I understand that if I have any risk concerns, I should discuss the risks with the WMAC’s management before I sign the associated Registration Form and before any Activities begin. I intend to be legally bound by this release and hereby for ourselves, or heirs, executors and administrators, waive, release, and forever discharge any and all rights and claims for damage which may hereafter arise against WMAC Inc, and its directors, officers, agents, representatives, successors, and assigns, for any and all damages which may be sustained or suffered by the participant (adult or minor) in connection with or arising out of our participation in Activates at the WMAC.
General Acknowledgement & Acceptance
I hereby acknowledge that all information and signatures on this are applicable to my or my minor’s participation in Activities at the WMAC’s facilities and I agree to abide by the rules and regulations specified in this document and provided through the WMAC in relation to the Activities in which we engaged.
Assumption of Risk of Serious Injury
I understand and appreciate that our participation in the sport of swimming and related Activities carries a risk of serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept, and assume this risk. I certify that, to the best of my knowledge and belief, I or my child are in good health and in proper physical condition for the anticipated conditions of the Activities engaged in and I agree that it is my sole responsibility to determine whether I am, or my child is, sufficiently fit and healthy enough to participate. I understand and acknowledge that physical and mental rigors associated with swimming, and realize that such Activities are inherently dangerous. I understand and acknowledge that I may be exposed to undetermined harm or damage which may not be readily foreseeable and other presently unknown risks and dangers. I understand that these risks may be caused in whole or in part by my own actions or inactions, the actions or inactions of others participating in the Activities, or the acts, inactions or negligence of the released parties. I agree to be familiar with and abide by the rules and regulations established for use of the facility. I also accept sole responsibility for me or my minor’s conduct and actions while participating in any Activity at the WMAC.
The signed individual, does hereby represent that they are the parent or legal guardian of the minor and agrees to save and hold harmless and indemnify each and all parties herein referred to above, as release, from all liability, loss, cost, claim or damage, whatsoever that may be imposed upon the WMAC Inc, and/or its directors, officers, agents, representatives, successors, and assigns because of any defect in or lack of such capacity to so act and release WMAC Inc, and its directors, officers, agents, representatives, successors, and assigns on behalf of the signed individual.
The Waiver and Release Form shall be constructed in accordance with and subject to the laws of the State of New Hampshire. If any paragraph, section, sentence, clause or phrase contained in this Waiver and Release Form becomes or is held by any court of competent jurisdiction to the illegal, null, or void or against public policy, the remaining paragraphs, sections, sentences, clauses, or phrases contained in the Waiver and Release Form shall not be affected thereby.
Medical Release
This is to certify on this date that I, as the parent/legal guardian of the minor participating in any and all activities of the WMAC, give my consent to WMAC and its medical representatives to obtain medical care from any licensed physician, hospital or clinic for the above-mentioned minor for injury that could arise from activities if I am not present. I also give my consent to WMAC and its medical representatives to obtain medical care for myself if the need shall arise.
Media Release
By signing this release, I as the parent or guardian, agree to allow WMAC to utilize any photograph, video, statement, etc. in promotional and advertising materials.
Acceptance of Terms and Conditions *
Check here if you agree to the conditions of this waiver, release of liability, and consent for medical treatment.
Electronic Signature *
Please type your full name
Payment *
Your registration will be confirmed when your payment clears
Comments or Questions
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