2024 Lake City Skiers Membership Form
2455 Hidden Lake Drive, Warsaw, Indiana 46580
This form must be completed before the member is allowed to take part in any team activity including: practices, shows, work days or competitions.
(Form updated on 3/14/2024).
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Last Name *
First Name *
Middle Initial *
Date of Birth *
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Male or Female *
Phone Number *
Email *
Address (Street) *
Address (City) *
Address (State) *
Address (Zip Code) *
Main Participation Level *
USA Water Ski Membership/Insurance Number (You must have your correct number filled in or your form is not valid) *
USA Water Ski Membership/Insurance Renewal Date
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USA Water Ski Safe Sport Renewal Date (Must be current or your form is not valid)
*If you are a minor and don't need to do this, please enter your insurance renewal date*
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Team Membership
*Family membership includes members of the immediate family. Members must obtain their own individual membership upon reaching age 18, as of January 1, unless they are a full-time student and can be claimed as such under the IRS tax laws. Applicants under the age of 16 are also encouraged to join through a family membership or have an individual non-skiing support parent/guardian as a member.

Checks for team membership can be made out to "Lake City Skiers" and given to Athena Stenstrom.*
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Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Relationship *
Allergies or Health Information
*If none, type none*
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Preferred Hospital *
Type of Insurance *
Insurance Provider
*If none, type none*
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Family Doctor
*If none, type none*
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Family Doctor Phone Number
*If none, type none*
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Lake City Skiers Code of Conduct & Eligibility
The following actions are prohibited:
1. There shall be no consumption of any alcoholic beverages, drugs or intoxicants before or during ski practices or shows. Use or possession of any illegal drugs will be an immediate expulsion from the team and property.
2. No mass messaging, such as emails and/or text messages, or press releases pertaining to the business of the Lake City Skiers may be sent unless approved by the Board of Directors.
3. Aggressive or disrespectful behavior towards any team member, board member and/or audience member will result in limited participation on the team for an approved amount of time deemed by the Board of Directors.
4. Profanity and disrespect for fellow team members and club officers will not be tolerated.
5. All team members are expected to help with the setup and tear down of equipment before and after tournaments, shows and practices. Theft or inappropriate removal of another's property will not be tolerated.
6. The above list of examples is not intended to be a comprehensive, all-inclusive list of infractions. Membership with the Lake City Skiers is at the consent of the Board of Directors of the Lake City Ski Club and the member and either party may terminate that relationship at any time, with or without advanced noticed. Violation of any of these rules can result in suspension or termination from the Lake City Ski Club.
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Required
The following actions are required for eligibility:
1. Attend shows (2 per week)
2. Attend practices (1-2 per week)
3. Attend tournaments (3 per season)
4. Help set up/put away equipment for shows & practices
5. Learn new things (even how to ski, during "open" ski time only)
6. Positive attitude
7. Serve on a committee (A minimum of 15 hours of service)
8. "Earn" a skiing position in the show (no one is guaranteed a position in the show)
9. Help at all shows, even if you are not yet skiing in the shows
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Required
Committees:
(Must serve a minimum of 15 hours)
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Required
Lake City Skiers Waiver and Release of Liability
In consideration of being allowed to participate in any way with the Lake City Skiers and related events and activities, the undersigned:
1. Agree that the parent(s) or legal guardian(s) will instruct the minor participant that prior to participating the he/she should inspect the facilities and equipment to be used and if the participant believes anything is unsafe, he/she should immediately advise his/her coach/supervisor of such condition(s) and refuse to participate
2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury including permanent disability and/or death and severe social/economic losses which might result not only from their own actions, inactions or negligence but the action inaction or negligence of others, the rules of play or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.
3. Assume all the foregoing risk and accept personal responsibility for the damage following such injury, permanent disability or death.
4. Release, waive, discharge and covenant not to sue the Lake City Skiers, its affiliated clubs, respective administrators, directors, agents, coaches and other members of the organization, other participants, sponsoring agencies, sponsors, advertisers and if applicable, owners and lessees of premises used to conduct the event, all of which are hereinafter referred to as "releases", from any and all liability to the undersigned, his/her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or part by the negligence or the releases of otherwise.
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Required
I do consent to the use of my photograph in the promotion of the Lake City Skier Water Ski Show Team. This includes all media, internet, program advertisement books, promotional billboards or any other means of advertising using team or individual photos. *
Required
As evidenced by the checked box, I certify that I have read and understand all of the foregoing and consent to abide by the rules as set forth herein.

I, THE PARTICIPANT, AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER, HAVE READ THIS DOCUMENT AND I UNDERSTAND ITS CONTENTS. I acknowledge that waterskiing or any sporting event is an extreme test of a person's physical and mental limits and carries with it the potential for death, serious injury or property loss. With a full understanding of the potential risks, I HEREBY ASSUME THE RISKS OF PARTICIPATING IN A WATER SKI EVENT.
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Required
For athletes of minority age - (under the age of 18 at the time of registration) This is to certify that I, as parent/guardian of the participant, have explained to my son/daughter the aforementioned stipulated conditions and their ramifications and I consent to his/her participation in the programs conducted under the auspices of USA Water Ski, Lake City Skiers and the Central Region Show Ski Association of which he/she is a member. I understand that all members under the age of 14 MUST BE accompanied by an adult at all times. *
Required

Property Owner Waiver

Acknowledgment, Release, Medical Authorization, Uniform Participation, and Hold Harmless Agreement

For and in consideration of acceptance of this request and permission to participate in any event or use Hidden Lake and/or any facility or property owned or operated by Randy and Tracey Patrick and their heirs, successors or assigns, the undersigned for themselves, their heirs, successors, invited or not invited guests and/or the minor participant for whom they signed do acknowledge, warrant and agree as follows:

1. The participant or participants are competent to safely participate in the event and will be fully responsible for his/her own safety and well-being at all times, including the safety and sufficiency of all equipment used, and also included his/her safety at all times and under all circumstances while at the event site. The participant and Parent or Guardian, where applicable warrant and promise that they will assume full responsibility for their conduct and safety at all times, whether or not in actual participation and/or at the event site.

The undersigned acknowledges, agrees and fully understands that [the undersigned] [the minor child of the undersigned and/or [the group represented by the undersigned] will be engaging in activities that involve risk of serious injury, or death, and severe social and economic losses which might result not only from the actions, inactions or negligence of [the undersigned] [the minor child of the undersigned and/or the group represented by the undersigned], but also from the action, inaction or negligence of others, the rules of play, or the condition of the premises or of any equipment used, or of the lake or its facilities. The undersigned further acknowledges and fully understands that there may be other risks that are not known and may not be reasonably foreseeable on the date hereof.

2. The undersigned acknowledges and assumes the risk of serious injury and/or loss of life from participating in the event, and, in connection therewith promise, agree and warrant as follows:

a) To release, hold harmless, protect, indemnify and forever discharge the sponsors and organizers of the event, its officials, members and co-participants in the event, the land or site owner, lessor, lessee, public or governmental agency having jurisdiction thereof, and/or the site operator, and any agency that may be assigned to cover the event, their agents, servants, employees and all persons connected with the event, from any and all rights, claims and demands of any nature for any and all loss, damage or injury sustained by the participants or his or her equipment at any time during the event or before or after the event but in connection with it; and further promises and agree never to institute any claim suite or action at law against any such organization or individual described herein above.

b) The undersigned is of legal age and competent to enter into this agreement, and/or the parent and/or guardian of the minor participant on whose behalf they sign, and hereby agrees to indemnify and hold harmless to the full extent described in paragraph a) above, those organizations and individuals named or described therein from and against any claim or suite due to injury or damage to the person or property of said minor participant;

c) The undersigned hereby authorize the event organizers, directors, participant or their designee to seek and procure on their behalf all reasonable medical and surgical care which might be required in the event of injury to a participant who is or becomes unable to authorize such care, and warrant their financial responsibility for such treatment as is rendered.

d) The undersigned grant to the event organizers and Randy and Tracey Patrick the right to make and use any photographs, television or motion pictures taken during the event, and agree that the organizers have the right to control or prohibit advertising material used, worn or displayed by a participant at the site during the event;

e) The event organizers and director reserve the right to disqualify the participant and/or at their sole and unqualified discretion, to refuse to allow the participant to participate in the event for any reason they deem just and proper, and In such event the participant will forfeit any fees or donations.

I have read all of the above. I understand it and agree to all terms and conditions and affirm all promises, representations and warranties made by me as a condition and consideration for the privilege of participating in the event. I agree to be fully responsible for my conduct at the event and/or for the conduct of the minor on whose behalf I sign. [If signing for a minor, use two lines and indicate who is the parent and who is the minor]. If signing as an event organizer, I agree to be fully responsible for invited or not invited guests, attendees, and participants. I also agree to be responsible for replacement or repair (at owner’s discretion) of any and all damages to property or equipment and any costs, fees and losses incurred by owners.

The following is prohibited: glass containers, public intoxication, minors consuming alcohol, use of drugs or any illegal activity (such activity will result in police intervention and possible arrest). All violators will be prosecuted.

I understand and agree to the terms above. (Please type your name in the following section. If signing for a minor, use two lines and indicate who is the parent and who is the minor.)


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Hidden Lake Agreement

Agreement for the use of Hidden Lake and Designated Areas for recreational and competitive water skiing and any other approved purposes.

Property access will be at specifically designated and previously approved days and times only. Each and every day specifically declaring the time and purpose must be agreed upon in writing and in advance with owners reserving full right to cancel at any time with or without reason or just cause.

No alterations in landscaping or shoreline. No removal of trees or bushes, etc., No addition of buildings or construction of any kind without prior approval from property owners.

 Any and all team equipment and member’s personal property must be stored properly inside approved storage buildings after each practice, show or event.

 Site must be properly maintained. Mowed and trimmed on a regular basis. All trash must be removed weekly. A dumpster must be provided by the Lake City Skiers.

 Lake weeds and surrounding show site areas must be sprayed with an approved chemical at the time and manner approved by property owners.

This agreement does not provide for fishing or other property use except as specifically declared.

 

Lake City Skiers accept full responsibility for and to maintain and assure the following:

 1)     All boats will be insured according to USA Waterski Tournament guidelines and will name property owners as additionally insured.

2)     All drivers will be approved and licensed through USA Waterski guidelines and requirements.

3)     Jumps, bleachers and docks will be maintained and kept in a safe manner with quality construction materials.

4)     All events, practices and functions of any kind will be properly sanctioned according to USA Waterski requirements.

5)     All members must sign and return a liability waiver, submit a photocopy of their USA Waterski membership and acknowledge these rules and provisions of agreement prior to any activities.

6)     Skiers will wear proper required flotation and follow safety guidelines at all times.

7)     There will be no discharge of pollutants, chemicals, waste products, fuels or lubricants in the water, on the land or in the roadway.

8)     Assure that every member, family member and guest (invited or not invited) attending practice and team events (not open to the public) must sign property owner waiver.

9)     Club takes full responsibility to assure that all participants (anyone on the dock, in a boat, in the pre-staging area or concessions area is an active USA Waterski member and property owner waiver is signed.

I understand and agree to the terms above. (Please type your name in the following section. If signing for a minor, use two lines and indicate who is the parent and who is the minor.)

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Lake City Skiers - Covid-19 Acknowledgement

PLEASE READ CAREFULLY

I acknowledge the contagious nature of the Coronavirus/Covid-19 and that the CDC and many other public health authorities still recommend practicing social distancing.

I further acknowledge that the Lake City Skiers has put in place every reasonable precaution to reduce the spread of the Coronavirus/Covid-19.

I further acknowledge that the Lake City Skiers cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/Covid-19 may result from the actions, omissions or negligence of myself and others, including, but not limited to: team members, their families and members of the general audience and that such exposure may result in personal injury, illness, permanent disability and/or death.

I voluntarily agree to assume all of the forgoing risks and accept sole responsibility for any injury that I may experience or incur in connection with my participation with the Lake City Skiers. I hereby release, covenant not to sue, discharge and hold harmless the Lake City Skiers from and waive any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself or property that may be caused by any act, or failure to act, or that may otherwise arise in any way in connection with any activity involving the Lake City Skiers.

FOR ATHLETES OF MINORITY AGE - This is to certify that I, as parent/guardian of the participant, have explained to my child/dependent the aforementioned risks and precautions being taken by the Lake City Skiers and I consent to his/her participation in the programs conducted by the Lake City Skiers.

I understand and agree to the terms above. (Please type your name in the following section. If signing for a minor, use two lines and indicate who is the parent and who is the minor.)  
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COVID-19 Event Questionnaire and Waiver Release

USA Water Ski & Wake Sports (USA-WSWS) is dedicated to protecting the health and safety of our members.

I attest that I am not experiencing any symptoms of illness such as a fever, cough, or shortness of breath. If I develop these symptoms, I agree that I will leave the event premises immediately. I am aware that I must follow the safety and hygiene protocols of the event organizer.

I attest that:

• I have not traveled internationally in the past 14 days

• I have not traveled to a highly impacted area within the United States in the past 14 days

• I do not believe that I have been exposed to a person with a confirmed or suspected case of COVID-19 in the past 14 days

• I have not been diagnosed with COVID-19 or have been cleared as non contagious by state or local public health authorities

• I am following recommended guidelines as much as possible - practicing social distancing, trying to maintain separation of six feet from others, and otherwise limiting my exposure to the coronavirus.

I understand, acknowledge and assume the risks and dangers associated with participation in the sport of water skiing, wake sports and related water sport disciplines and activities, including without limitation, the potential for serious bodily injury, sickness and disease (including COVID-19), permanent disability, paralysis and loss of life; loss of or damage to equipment/property; exposure to extreme conditions and circumstances; contact with other participants, spectators, boats, animals or other natural or manmade objects; dangers arising from adverse weather conditions; imperfect ski course conditions; water and surface hazards; equipment failure; inadequate safety measures; participants of varying skill levels; situations unknown to or beyond the immediate control of the Event Organizers; and other undefined, not readily foreseeable and presently unknown risks and dangers (“Risks”). I understand that these Risks may be caused in whole or in part by my own actions or inactions, the actions or inactions of others participating in the Event(s), or the negligent acts or omissions of the Released Parties defined below, and I hereby expressly assume all such Risks and responsibility for any damages, liabilities, losses or expenses which I incur as a result of my participation in the Event.

I understand and agree to the terms above. (Please type your name in the following section. If signing for a minor, use two lines and indicate who is the parent and who is the minor.)  
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