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Liability Waiver
Participant Name______________________________________________
Age ____________Phone Number___________________________
I certify that I am volunteering to participate in (activity
name/description)_______________________________________
Scheduled for (Date): ____/____/________(Time)________ and
(Location)_______________________________
I
further certify that I am in good health and have no physical or other impediment which would endanger me while participating
in this activity. I will not be under the influence of drugs or alcohol, which
would impair my ability. I acknowledge and agreed this activity has inherent
risks. I have full knowledge of the nature and extent of all the risks associated
with this activity.
In
consideration of my participation in this activity, I agree (on behalf of myself, my heirs, executors, administrators, and
assigns) to release, discharge, waive and relinquish the Brandywine Swim Club (or its officers, agents, employees and volunteers)
from any and all liabilities, claims, or actions for personal injury, property damage, or wrongful death which may arise out
of my participation.
Participant Signature _____________________________________
Date ____/____/________
Parental/Guardian Consent: (To be completed
and signed by parent/guardian for participants under 18 years of age). I certify that I am the parent or legal guardian of
the above participant and that I am entitled to his or her custody and control and I do hereby give permission for the Child
to participate in the above activity. I further certify that the Child is in
good health and has no physical or other impediment which would endanger him or her while participating in this activity. I realize that by participating in this program, the Child will be exposed to a risk
of injury or death. I understand the dangers incidental to participating in the
program and the need for safety precautions, and I have discussed the dangers of the program and the need for safety precautions
with the Child. I hereby execute the above Agreement Waiver, and Release
on his/her behalf.
Parent/Guardian Signature _______________________________________________
Adult/Parent Name Printed __________________________Date____/____/________
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