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Swim With Gina Adult Waiver

Participation Agreement, RELEASE, INDEMNITY, and HOLD HARMLESS

This document affects your legal rights. You must read and understand it before initialing and signing it.

ACTIVITIES PARTICIPANT MAY TAKE PART IN: Swimming/Associated Exercise (the "Activities")

I, being the above named Participant (hereinafter jointly and severally referred to as "Participant," "I," "Me," "Myself," "My"), in consideration of the services provided by the Released Parties and the right to engage in or attend the Activities as a participant, volunteer or spectator, hereby acknowledge, agree, promise and covenant with Gina Hester individually and d/b/a Swim With Gina, James Hester and their partners, agents, independent contractors and employees (collectively, "Swim With Gina"), as well as any third party whose pool or other swimming facilities are used to host and/or conduct the Activities, including, but not limited to Trinity Episcopal School, Trinity Church Marshall, Trinity Supporters, Inc., Stafford Wellness Center, Crossing Creeks Country Club, and any Host Homes (the "Third Parties") (collectively, the "Released Parties"), on behalf of myself, my heirs, assigns, personal representatives and estate as follows:

ACKNOWLEDGMENT OF RISKS: I UNDERSTAND AND ACKNOWLEDGE that the Activities in which Participant is about to voluntarily engage in have certain anticipated and unanticipated risks which could result in INJURY, DEATH, ILLNESS OR DISEASE, PHYSICAL OR MENTAL DAMAGE to Participant, to Participant's property or to other parties or their property.  These risks include, but are in no way limited to, the following: 1) The risks which are inherent in the activities of swimming, 2) The acts or omissions or negligence in any degree of Released Parties, 3) Latent or apparent defects or conditions in equipment or property, 4) Third Parties provides NO LIFEGUARDS, 5) Improper coaching or inadequate supervision, 6) Improper chemical balance.

ACCEPTANCE OF RISK AND RESPONSIBILITY. WE VOLUNTARILY AGREE, COVENANT AND PROMISE TO ACCEPT AND ASSUME ALL RESPONSIBILITIES AND RISK FOR INJURY, DEATH, ILLNESS OR DISEASE to Myself or to My property or other parties and their property arising from My participation in the Activities. My participation in the Activities is voluntary.

MEDICAL CARE, PARTICIPANT INSURANCE BENEFITS AND REPRESENTATION OF PHYSICAL CONDITIONS: WE UNDERSTAND AND ACKNOWLEDGE that no major medical or accident insurance benefits will be provided to Me during participation or viewing of the Activities. I certify that I have sufficient health, accident, and personal liability insurance to cover any bodily injury or property damage that I may incur while participating in the Activities, and to cover bodily injury or property damage caused to another party as a result of My participation in the Activities. If I have no such insurance, I certify that I am capable of personally paying for any and all such expenses or liability.  I FURTHER ACKNOWLEDGE that Participant is in good physical and mental health, and not suffering from any condition, disease or disablement, which would or could potentially affect participation in the Activities. I give My consent and permission to the Released Parties and medical personnel to obtain or administer first aid and emergency medical treatment in case of sickness, accident, injury and to secure medical care at My expense and to make decisions concerning medical care if I am unable to do so. I give consent for drug testing to be performed in the event of any accident or during the course of any medical care or treatment for Myself.

RELEASE: I VOLUNTARILY RELEASE AND FOREVER DISCHARGE AND COVENANT NOT TO SUE ANY OF THE RELEASED PARTIES, from or for any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with My participation in the Activities, including, but not specifically limited to any and all negligence, fault or strict liability of any of the Released Parties for any and all injury, death, illness or disease, and damage to Myself or to My property.  I FURTHER, AGREE, PROMISE AND COVENANT TO HOLD HARMLESS AND TO INDEMNIFY EACH OF THE RELEASED PARTIES from all liability, claims, demands, actions or rights of action, damages, defense costs, including attorney’s fees, or from any other costs incurred in connection with claims for bodily injury or property damage which I may negligently or intentionally cause to other parties in the course of My participation in the Activities. I FURTHER AGREE, PROMISE AND COVENANT NOT TO SUE, ASSERT OR OTHERWISE MAINTAIN ANY CLAIM AGAINST ANY OF THE RELEASED PARTIES, for any injury, death, illness and disease, or damage to Myself or to My property, arising from or connected with My participation in this activity or from any claims asserted against Me by other parties. IN SIGNING THIS DOCUMENT,I FULLY RECOGNIZE THAT IF ANYONE IS HURT OR DIES, OR PROPERTY IS DAMAGED WHILE I AM ENGAGED IN THE  ACTIVITIES, I WILL HAVE NO RIGHT TO MAKE A CLAIM OR FILE A LAWSUIT AGAINST ANY OF THE RELEASED PARTIES EVEN IF ANY OF THE RELEASED PARTIES NEGLIGENTLY CAUSED THE BODILY INJURY OR PROPERTY DAMAGE. This agreement shall be binding upon the heirs, legal representatives, executors and administrators of the Participant and is for the benefit of the Released Parties, and their heirs, successors and assigns.

ACKNOWLEDGMENT OF EFFECT OF THIS RELEASE AGREEMENT: i UNDERSTAND AND ACKNOWLEDGE that by initialing and/or signing this document I have given up certain rights and/or possible claims which I might otherwise assert or maintain against the Released Parties, including specifically, but not limited to, rights arising from or claims for the acts or omissions, fault, negligence in any degree of any of the Released Parties. I understand and acknowledge that by signing this document, I HAVE ASSUMED RESPONSIBILITY AND LEGAL LIABILITY for the claims or other legal demands, including defense costs, which may be asserted by other parties against me as a result of My participation in the Activities.

INDEMNIFICATION: I, being each of the undersigned individuals, recognizes and understands that Gina Hester and James Hester do not own the real property, the swimming pool or any other facilities upon or at which the Activities are conducted.  I consent to use of third party facilities and am doing entirely upon My own initiative, risk and responsibility.  Furthermore, I am aware of the risks and hazards inherent upon the use of third party facilities, which include, but are not limited to, the swimming pool and bathroom area(s) located upon third party premises.  To the extent permitted by law, PARTICIPANT AGREES to indemnify, hold harmless, and defend the Released Parties from and against any and all losses, claims, liabilities and expenses, including reasonable attorney fees, if any, which Released Parties may suffer or incur in connection with MY USE OR MISUSE OF ANY PART OF THE PROPERTY, INCLUDING BUT NOT LIMITED TO LOSSES, CLAIMS, LIABILITIES AND EXPENSES, INCLUDING REASONABLE ATTOURNEY'S FEES, WHICH ARISE FROM THE NEGLIGENCE, GROSS NEGLIGENCE, OR INTENTIONAL MISCOUNDUCT OF ONE OR MORE OF THE REALEASED PARTIES, THEIR EMPLOYESS, SERVANTS, OR AGENTS. This release shall be binding upon the spouse, heirs, next of kin, executors, and administrators of each of the undersigned.

ENTIRE AGREEMENT: I understand that this document contains the entire agreement between Released Parties and Myself, that it is for the benefit of all Released Parties, and that it cannot be modified or changed in any way by the representations or statements of Released Parties or any employee or agent of Released Parties or any of the Released Parties or by me. My signature below indicates that I have read this entire document, understand it completely, and agree to be bound by its terms.

I, the undersigned, declare that I am signing this document and any subsequent documents that may be required, freely, without any fraud or duress, and acknowledge that I have read and understand the same. 

DO NOT Sign this if you do not Understand the contents of the agreement

April 27, 2024

First Participant Name

First Name*

Last Name*
First Participant Date of Birth*
First Participant Information
Do you authorize permission for your photo to be used?*
No
Yes
First Participant Signature*
Second Participant Name

First Name*

Last Name*
Second Participant Date of Birth*
Second Participant Information
Do you authorize permission for your photo to be used?*
No
Yes
Third Participant Name

First Name*

Last Name*
Third Participant Date of Birth*
Third Participant Information
Do you authorize permission for your photo to be used?*
No
Yes
Fourth Participant Name

First Name*

Last Name*
Fourth Participant Date of Birth*
Fourth Participant Information
Do you authorize permission for your photo to be used?*
No
Yes
Fifth Participant Name

First Name*

Last Name*
Fifth Participant Date of Birth*
Fifth Participant Information
Do you authorize permission for your photo to be used?*
No
Yes
Sixth Participant Name

First Name*

Last Name*
Sixth Participant Date of Birth*
Sixth Participant Information
Do you authorize permission for your photo to be used?*
No
Yes
Seventh Participant Name

First Name*

Last Name*
Seventh Participant Date of Birth*
Seventh Participant Information
Do you authorize permission for your photo to be used?*
No
Yes
Eighth Participant Name

First Name*

Last Name*
Eighth Participant Date of Birth*
Eighth Participant Information
Do you authorize permission for your photo to be used?*
No
Yes
Ninth Participant Name

First Name*

Last Name*
Ninth Participant Date of Birth*
Ninth Participant Information
Do you authorize permission for your photo to be used?*
No
Yes
Tenth Participant Name

First Name*

Last Name*
Tenth Participant Date of Birth*
Tenth Participant Information
Do you authorize permission for your photo to be used?*
No
Yes
Participant Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Additional Enrollment Information
May we text?*
No
Yes
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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*
Parent or Guardian's Information
Do you authorize permission for your photo to be used?*
No
Yes
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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