COVID Form WI Swimming 2021-'22
This Waiver of Liability, Release, and Indemnity Agreement must be competed by all athletes and their parent/legal guardian(s) who act as a meet volunteer, coaches, timers, and officials for EVERY team associated with CWSC and/or NLAC (close to 600 individuals).
Completion of this form covers any one or all of the NLAC WI Swimming approved meets for the winter season of 2021-'22 ONLY and is good for the following dates at the following facilities:
November 27 at Rice Lake Aquatic Center
December 4 at Rhinelander High School and/or at Phillips Aquatic Center
December 11 at Merrill Middle School and/or at Tomahawk High School
December 18 at Lakeland High School and/or at Ladysmith High School
January 8 at Rice Lake Aquatic Center and/or at Rhinelander High School
January 15 at Phillips High School and/or at Antigo Aquatic Center
January 22 at Lakeland High School and/or at Black River Falls Aquatic Center
January 29-30 at Medford High School and/or at Ladysmith High School
February 5-6 at Merrill Middle School
For questions regarding help in completing this form, please contact Shari Bergman at 715-748-9572 or
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Category of Individual Attending
Volunteer (including a timer)
Adult Athlete (18 or Over)
Last name of individual indicated above:
First name of individual indicated above:
Team associated with:
Black River Falls
Eau Claire Aquatics
First and last name of parent/legal guardian of minor athlete listed above (if applicable):
You acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that your family, including child(ren), may be exposed to or infected by COVID-19 while on site at the pool or facility and that such exposure or infection may result in personal injury, illness, permanent disability, and death. You understand that the risk of becoming exposed to or infected by COVID-19 at the pool or facility may result from the actions, omissions, or negligence of myself and others, including, but not limited to, the Hosting Swim Team, Hosting Swim Facility, Northern Lakes Aquatic Club (hereinafter referred to as “NLAC”) and pool management company's employees, volunteers, and program participants and their families.
I acknowledge and understand the above statement.
You acknowledge, the Hosting Swim Club, the Hosting Swim Facility, NLAC, Wisconsin Swimming, Inc., and USA Swimming, Inc., cannot prevent you (or your child(ren)) from becoming exposed to, contracting, or spreading COVID-19 while participating in USA Swimming sanctioned events. It is not possible to prevent against the presence of the disease. Therefore, if you choose to participate in a USA Swimming sanctioned/approved event, you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. You agree that you, or your child, are voluntarily participating in these activities, with knowledge of the risks associated with such activity.
I agree and acknowledge the above statement.
You acknowledge and agree that neither the Hosting Swim Club, Hosting Swim Facility, NLAC, Wisconsin Swimming, Inc., and USA Swimming, Inc., nor you will be liable to the others for any special, indirect, incidental or consequential damages arising out of this Agreement. Except as otherwise specifically set forth herein, the Hosting Swim Club, Hosting Swim Facility, NLAC, Wisconsin Swimming, Inc., and USA Swimming, Inc.’s total liability to you under or in connection to this Agreement shall not exceed the amounts paid or payable to the Hosting Swim Club, Hosting Facility, NLAC, Wisconsin Swimming, Inc., and USA Swimming, Inc. according to this agreement; Any action against the Hosting Swim Team, Hosting Swim Facility, NLAC, Wisconsin Swimming, Inc., and USA Swimming, Inc. arising out of, resulting from, or related to the performance or breach of this Agreement shall be filed not later than three (3) months after the cause of action has accrued. You agree that should any part of this agreement be found by a court of law to be against public policy or in violation of any state statute or case precedence, then the remainder of this document will remain in full force. By signing below, you understand and agree to the terms stated above. You understand the risks associated with Swimming Competition. IN ADDITION, BY SIGNING BELOW, YOU RELEASE THE HOSTING SWIM TEAM, HOSTING SWIM FACILITY, NLAC, WISCONSIN SWIMMING, INC., AND USA SWIMMING, INC. FROM ANY AND ALL LIABILITY FOR ANY INJURY OR DAMAGE THAT MAY ARISE FROM, BUT NOT LIMITED TO, YOUR PARTICIPATION IN (A) ANY ACTIVITY, CLASS, PROGRAM, PERSONAL TRAINING OR INSTRUCTION, (B) THE SUDDEN AND UNFORESEEN INJURIES ARISING OUT OF YOUR IMMEDIATE SURROUNDINGS, (C) OUR INSTRUCTION, TRAINING, OR SUPERVISION. THE FOREGOING UNDERSTOOD, YOU, YOUR HEIRS, ASSIGNS, AND YOUR PERSONAL REPRESENTATIVE HEREBY RELEASE AND WAIVE ANY AND ALL CLAIMS AGAINST THE HOSTING SWIM TEAM, HOSTING SWIM FACILITY, NLAC, WISCONSIN SWIMMING, INC., AND USA SWIMMING, INC., ITS OWNERS, OFFICERS, VOLUNTEERS, COACHES AND EMPLOYEES, CONTRACTORS, AND ANY OTHER PARTIES CONNECTED TO THE SERVICES IN ANY WAY (“RELEASEES”) SINGULARLY OR COLLECTIVELY, AND FURTHER HOLD HARMLESS AND INDEMNIFY SUCH RELEASEES FROM AND AGAINST ANY LIABILITY, CLAIMS OF NEGLIGENCE, MISADVENTURE, HARM, LOSS, INCONVENIENCE OR DAMAGE HEREBY SUFFERED OR SUSTAINED AS A RESULT OF YOUR PARTICIPATION IN THE SERVICES, OR ANY OTHER SERVICES OR ACTIVITIES OFFERED BY RELEASEES. THE FOREGOING NOTWITHSTANDING, THIS IS NOT A RELEASE AND WAIVER OF INTENTIONAL OR RECKLESS ACTS OF RELEASEES. SUCH RELEASE, WAIVER, HOLD HARMLESS AND INDEMNITY SHALL APPLY TO YOUR OWN CLAIMS AND/OR CLAIMS OF THIRD PARTIES, RELATING TO MY PARTICIPATION IN THE SERVICES. YOU HAVE READ AND UNDERSTAND THIS AGREEMENT. YOU HAVE HAD THE OPPORTUNITY TO BARGAIN WITH THE HOSTING SWIM TEAM, HOSTING SWIM CLUB, NLAC, WISCONSIN SWIMMING, INC., AND USA SWIMMING, INC. WITH ADEQUATE INSURANCE OR AN ADEQUATE CASH DEPOSIT TO NOT HAVE TO AGREE TO THE WAIVERS OR RELEASES OF LIABILITY OR INDEMNIFICATION PROVISIONS SET FORTH HEREIN. YOU UNDERSTAND THAT YOU HAVE WAIVED AND SURRENDERED VALUABLE LEGAL RIGHTS. YOU HAVE SIGNED THIS WAIVER VOLUNTARILY; AFTER DUE NEGOTIATIONS, IN EXCHANGE FOR THE CONSIDERATION DESCRIBED ABOVE. This Agreement and its terms bond a relationship between the Hosting Swim Team, Host Swim Facility, NLAC, Wisconsin Swimming, Inc., and USA Swimming, Inc. and yourself. Each time you participate in these activities, you affirm the terms of this Agreement and agree to indemnify and hold the Hosting Swim Team, Hosting Swim Facility, NLAC, Wisconsin Swimming, Inc., and USA Swimming, Inc. and its employees harmless from all liability and claims, as stated above. The Services are provided under this Agreement by NLAC through sanction by Wisconsin Swimming, Inc., and USA Swimming, Inc.
Agree, acknowledge and understand.
Signature of Individual Attending or of Parent/Legal Guardian of Minor Named Above (type name of person completing this form).
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