2023 Private Swim Lesson Waiver Form
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Email *
Name of Instructor *
Parent/Guardian Name *
Are you a SHRC member for 2023? *
Swimmer Name and Age *
Medical conditions impacting participation? *
Medical conditions... *
RELEASE OF LIABILITY: I, the parent or legal guardian of the above named child(ren), hereby assume all risks and hazards of incidental to the conduct of swim clinic activities and transportation to and from those activities on behalf of my child.  I further agree to save and hold harmless, Summer Hill Recreation Club, Inc. and all its employees or agents, including all individuals who are affiliated with swimming programs administered by Summer Hill ("Summer Hill") as the result of personal or bodily injury or damages to me, my child or my ward incurred while participating in any activities administered by Summer Hill while coming to and going from those activities, and further release and agree to fully indemnify Summer Hill from liability in the event that damages are awarded against any of the above rising out of injuries to me, my child, or my ward while participating in or traveling to or from such activities. *
Required
Parent/Guardian, type your name below to serve as electronic signature for Release of Liability. *
 SUMMER HILL RECREATION CLUB, INC: 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. Summer Hill Recreation Club, Inc has put in place preventative measures to reduce the spread of COVID-19; however, Summer Hill Recreation Club, Inc cannot guarantee that you or your child(ren)/family/guests will not become infected with COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren), my family, my guests and I may be exposed to or infected by COVID-19 by participating in or attending an activity at one of Summer Hill Recreation Club, Inc’s facilities and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren), my family, my guests or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim,liability, or expense, of any kind, that I or my child(ren), my family, my guests may experience or incur in connection with my child(ren)’s/family’s/guests’ participation in the activity(“Claims”). On my behalf, and on behalf of my children, and on behalf of my family and guests, I hereby release, covenant not to sue, discharge, and hold harmless Summer Hill Recreation Club, Inc, its employees, agents, and representatives, 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 based on the actions,omissions, or negligence of Summer Hill Recreation Club, Inc, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any activity.   *
Required
Parent/Guardian, please type your full name and the date below to serve as and electronic signature for the Covid-19 statement. *
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