2020 SHBR Dive Waiver
This is a special waiver for families who want to participate in diving at SHBR during COVID-19 Quarantine. This must be signed by every family that has a diver (but multiple divers from the same family may be added on the same form).
Email address *
SHBR Participant Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Sleepy Hollow Bath & Racquet Club (SHBR) has put in place preventative measures to reduce the spread of COVID-19; however, SHBR cannot guarantee that you or anyone who enters any swimming pool and other related facilities and recreational areas operated and/or managed by SHBR will not become infected with COVID-19. Further, entering the SHBR facility may increase your risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I, and those I name below, may be exposed to or infected by COVID-19 by entering SHBR and by using the facilities, pool and related equipment and apparatus therein, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at SHBR may result from the actions, omissions, or negligence of myself and others, including, but not limited to, SHBR employees, coaches, representatives, contractors, officers, managers, and anyone else who may be at or near the SHBR facility when I am there (including other members and participants and customers of SHBR, and others who may be present at the SHBR facility while I am there). I voluntarily agree to assume all of the above mentioned risks and accept sole responsibility for any injury to myself and others who accompany me to the SHBR facility (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or those accompanying me may experience or incur in connection with being present at SHBR (herein “Claims”). On my behalf, and those accompanying me, I hereby release, covenant not to sue, discharge, and hold harmless SHBR, its employees, coaches, representatives, contractors, officers, managers, and anyone else who may be at or near the SHBR facility when I am there, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims related to a COVID-19 infection, whether such infection occurs before, during, or after appearing at SHBR. Furthermore, I agree to follow the rules and guidelines established by SHBR, the Dive Team Representative, and the dive coaches, including, but not limited to: *All divers will be verbally screened daily, as required by the State of Virginia, before being allowed inside the gates for practice.*No spectators, including parents, will be allowed inside the gates of SHBR during dive team events (including practice). *All coaches and divers must maintain at least 10 feet of physical distancing between each other at all times, except as consistent with social distancing practice layouts recommended by USA Swimming or the State of Virginia. *Showers and changing rooms at SHBR will be closed and bathrooms will only be available in case of emergency. *All divers must arrive at their appointed practice time and immediately depart thereafter, as directed by SHBR staff and coaches. Divers who do not arrive on time will not be admitted for practice. *Divers will not be allowed to stay on property if they are not in active practice. *Failure to adhere to the rules can result in divers being suspended from practice and repeated failure will result in divers being dismissed from practice.
I certify that I am the parent or legal guardian for my child(ren). I hereby give my permission for any coach or other team administrator associated with the The Sleepy Hollow Bath and Racquet Club, Inc. (SHBR), to take my family member to the emergency room of the nearest hospital, and the hospital and its medical staff have my authorization to provide treatment, which a physician deems necessary for my family member's well being. The respective SHBR team representative in travel situations will use this Permission for Emergency Care Form. As Parent/Guardian of the named minor(s), I grant permission for the swimmer(s) to participate in all activities of the SHBR Dive Team. I represent and warrant that my minor child/children participating on the SHBR Dive Team are in good health and have no physical condition, ailment or disability which renders them unable to participate in vigorous physical activity. For and in consideration of benefits derived from participation in the SHBR Dive Team program, I understand that the risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. I assume all risks and hazards arising out of, or related to, such participation, including, but not limited to, transportation to and from such activities, and do hereby indemnify, release and hold harmless the SHBR Dive Team, its coaches, team representatives, volunteers, property manager, employees and agents from all claims of any kind whatsoever which may arise or hereafter accrue in connection with my child’s/children’s participation in activities of the SHBR Dive Team. I further grant permission for first aid to be given to my child/children in an emergency, and will be solely responsible for any medical costs which may arise. (Please provide consent by entering your name below as an electronic signature.) *
I give permission for the following family members to participate in dive team at SHBR: *
A copy of your responses will be emailed to the address you provided.
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