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Thanks for partying with us! Please fill out the waiver below.  

I, the undersigned, for myself and my child(ren), understand that participation in a birthday party at Health Unlimited Family Fitness and Aquatic Center, and the use of the facilities at said Center, is potentially hazardous and involves a risk of injury and even death and that I, for myself and my child, am aware of these risks and are voluntarily participating in these activities. I hereby expressly assume and accept any and all risks of injury or death and do hereby waive, release and forever discharge, and indemnify and hold harmless Health Unlimited Family Fitness and Aquatic Center and its officers, agents, employees, representatives, and all others from any and all responsibility or liability for injuries or damages, except those caused by the gross negligence of any of the foregoing persons or entities, arising out of, resulting from, or in connection with my or my child’s participation in these activities or the use of said facilities and/or equipment.

 

Should a facility lifeguard deem my child’s swimming ability to be insufficient for safe participation in the pool, at any time, I understand that they will require my child to wear a life jacket while participating in swim activities.

 

I understand that it is my responsibility to inform the staff of Health Unlimited if I know of any reason why my child(ren) should not participate in swim activities, including, but not limited to, health concerns, injuries, swimming ability, or open wounds.

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Join Our Mailing List
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

Phone*
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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