WAIVER/RELEASE OF LIABILITY

WAIVER/RELEASE OF LIABILITY

PLEASE READ CAREFULLY BEFORE SIGNING.

THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS.

I, ____________________________________________________, the enrolled participant and/or the parent/guardian of the participant agree and understand that swimming is a HAZARDOUS activity. I recognize that there are risks inherent in the sport of swimming, including but not limited to paralyzing injuries and death.

The participant hereby agrees to participate in the Rappahannock Swim League program and hereby agrees to indemnify and hold harmless the Rappahannock Swim League, Inc., its coaches, officers, directors, agents, volunteers and employees, and its swim teams and their respective coaches, officers, directors, agents, volunteers and employees against any liability resulting from an injury that may occur to the participant while participating in the Rappahannock Swim League program. The participant also agrees to indemnify the Rappahannock Swim League, Inc. and the Hampton Oaks Swim Team for any damages incurred arising from any claims, demand, action or cause of action by the participant.

The participant authorizes any representative of the Rappahannock Swim League, Inc. or the Hampton Oaks Swim Team to have the participant treated in any medical emergency during their participation in the Rappahannock Swim League program. Further, the participant and/or the parent/guardian agree to pay all costs associated with medical care and transportation for the participant.

I have noted on the back of this form any medical/health problems of which the staff should be aware.

I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.

Signed: ___________________________________________Date:________________

(Participant)

Signed:_______________________________________Date:_______________

(Parent/Guardian)

Registration Form

Parent’s Name: _____________________________________________________

Street Address: ______________________________________________________

Telephone (H): _______________

Emergency Contact: _________________________________ (name and phone number)

Father’s Work Phone: ______________

Mother’s Work Phone: _____________

Parent’s E-Mail: __________________________________

Other E-Mail: ____________________________________

Swimmers:

Name: _______________________DOB: ____________ $__________

Concessions Fee $ 20.00

TOTAL $__________

HOST Season Fee: first child = $60.00, second child = $50.00, third child = $40.00, fourth child is free.

Family Fee Cap = $150.00 Basic Swimmer Fee + Family Concessions Fee of $20.00 = $170.00 total

Beginning in 2005, each HOST family will be charged a Concessions Fee of $20.00 which will alleviate the need for parents to bring food products to each home meet. This will improve concessions efficiency, minimize waste and simplify parent responsibilities.

I understand that I will be required to volunteer for each home meet in which my child(ren) participate(s) as well as 2 away meets. Further, I understand that I must volunteer to support the Division Finals if my child(ren) participates.

Signed:_________________________________Date:___________

(Parent/Guardian)

Please bring to registration April 6, 2005 or return to Andrea Adams,

720-3960, at 3 Exeter Lane along with Waiver/Release of Liability form.

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