Guest Rules, Rock Wall Waiver and COVID waiver

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Required form for anyone coming to Summer Break Swim Club as a guest

Full Name of legal guardian *

List family member #1 to be included on the waiver *

List family member #2 to be included on the waiver

List family member #3 to be included on the waiver

List family member #4 to be included on the waiver

List family member #5 to be included on the waiver

List family member #6 to be included on the waiver

I am the legal guardian to ALL minor(s) listed on this waiver. *

Yes

Required

Emergency contact Name *

Emergency contact phone number *

What is that person's relationship to the minors? *

Secondary Emergency contact

Secondary Emergency Contact phone number

Rock Wall and COVID-19 Waiver available at: www.summerbreakfishers.com Click Tab at the top of the page to view. *

I have visited the Summer Break website and have read and agree to all the legal terms and conditions included on the Rock Wall Waiver and the COVID-19 waiver.

Required

Pool Rules available at: www.summerbreakfishers.com Click Tab at the top of the page to view. *

I have visited the Summer Break website and have read and agree to all the Pool Rules listed.

By typing my name below, it will act as an electronic signature verifying that I am the parent or guardian to the listed minors on this form and I have read the online pool rules, rock wall waiver and COVID waiver and agree to the legal terms and conditions outlined for all people on this form for the entire 2022 season. *

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