2021-22 Swim Lesson Registration and Waiver

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If you are participating in a parent participation class, you must fill out a separate form for your child and yourself.

Email *

Name(First, Last) *

Date of Birth *

YYYY

Address *

City/Zip *

Best number to reach you at *

Do you receive texts at this number? *

Yes

Father's Name (answer N/A if you are an adult) *

Cell Number *

Mother's Name (answer N/A if you are an adult) *

Cell Number *

Please list two emergency contacts in case a parent cannot be reached in the event of an emergency. Name and Phone Number. *

Does your swimmer have any of the following? *

Food Allergy

Asthma

-Will inhaler be available?

Seizures

Diabetes

Daily Medications

Physical Disability

Cognitive Disability

no known allergies

Required

If you answered yes to any of the above questions, please explain.

I understand that the sign up is for the scheduled session and I will receive no refunds for missed lessons or no-shows. Make-up lessons will NOT be offered for closures beyond San Benito Aquatics control. I understand photos may be taken and may appear in promotions (web, ad, etc.) By typing my name I give my electronic consent. *

I am aware that COVID-19 is present in our community. I understand that SBA may take mine and my child's temperature upon entering the pool facility and we may be asked COVID-19 screening questions. I understand that we may, per the State of California Mask Order, wear a mask into and out of the facility. No one should wear a mask in the pool. I hold harmless San Benito Aquatics employees and officers as well as San Benito High School employees and officers in the event that someone in my family becomes positively infected with the COVID-19 virus. *

yes

I understand per the San Benito County Health Department and State of California, SBA may limit spectators on the pool deck. *

yes

RELEASE OF LIABILITY-READ BEFORE SIGNING.

In consideration of being allowed to participate in any way in the San Benito Aquatics Swim Lesson program, its related events, and activities, I acknowledge, appreciate and agree that:
1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of San Benito Aquatics immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS SAN BENITO AQUATICS, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used for the activity ("Releasees"). WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person to property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. -

By typing my name I give my electronic consent that I have read this release of liability and assumption of risk agreement, fully understand it's terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

SIGN HERE *

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE(UNDER THE AGE OF 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above all the Releasees, and for myself, my heirs, assigns and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. By typing my name i agree to these terms.

SIGN HERE *

A copy of your responses will be emailed to the address you provided.

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