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The following must be completed and signed by all adult members.

By signing this release, I/We hereby agree to defend, indemnify, hold harmless and release the Briarmoor Manor Recreation Club, its successors and/or assigns, its Board of Directors, Officers and Members (hereafter referred to as “The Club”) from any and all liability, losses (loss of life, limb, sight, etc.), damages and expenses incurred by and to myself, spouse, children, guest, invitees or any associates which might arise out of the use of any and all of the Briarmoor Manor Recreation Club facilities, particularly those facilities that are recreational in nature such as, but not limited to, the swimming pools, etc.

I hereby also authorize my minor child(ren), if any, over the age of 10 listed below to swim without parental or adult supervision during the periods when a lifeguard is present. I warrant that said child(ren) is/are fully capable of swimming without parental/adult supervision, and I allow them to do so without recourse against The Club in the event of injury to or death of the said listed child(ren). I certify that this/these child(ren) understand and shall comply with the current Briarmoor Manor Recreation Club Pool Rules available at https://www.Briarmoor manor pool.com/about-us.html. 




First Member Name

First Name*

Last Name*
First Member Date of Birth*
I certify that I am 18 years of age or older
First Member Signature*
Second Member Name

First Name*

Last Name*
Second Member Date of Birth*
Third Member Name

First Name*

Last Name*
Third Member Date of Birth*
Fourth Member Name

First Name*

Last Name*
Fourth Member Date of Birth*
Fifth Member Name

First Name*

Last Name*
Fifth Member Date of Birth*
Sixth Member Name

First Name*

Last Name*
Sixth Member Date of Birth*
Seventh Member Name

First Name*

Last Name*
Seventh Member Date of Birth*
Eighth Member Name

First Name*

Last Name*
Eighth Member Date of Birth*
Ninth Member Name

First Name*

Last Name*
Ninth Member Date of Birth*
Tenth Member Name

First Name*

Last Name*
Tenth Member Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Minors Over the Age of 10 Authorized to Swim Without Parent/Guardian Supervision

Minor #1's Name

Minor #2's Name

Minor #3's Name

Minor #4's Name

Minor #5's Name

Minor #6's Name
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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