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Hingham Maritime Center's Swim Self-Certification and Water Risk Acceptance Waiver

HINGHAM MARITIME CENTER, INC.

Risk Acknowledgment / Swimming and Physical Ability Self-Certification

 

I, on behalf of myself or my child, acknowledge and understand the following:

1. That rowing and sailing at Hingham Maritime Center, Inc. are activities that takes place on coastal, ocean, and unprotected waters and may require the ability to swim for extended periods of time without the possibility of immediate rescue or recovery.

I Agree
2.  That a Swimming and Physical Ability Self-Certification may or may not be a sufficient measure for my or my child's performance in any particular set of conditions.

I Agree
3.  That environmental conditions such as, but not limited to, water temperature, air temperature, wind speed, tide, and sea state may reduce the period of time my or my child's body can function properly in the event of circumstances requiring rescue or recovery.

I Agree
4.  That the maritime environment is a dynamic environment, and that many resources such as, but not limited to, advice, guidance, environmental readings, numeric calculations, and human predictions of weather conditions exist to provide support for the decision to participate in the activities/programs/classes offered by Hingham Maritime Center, Inc., and that the aforementioned resources may or may not be correct, valid, or suitable. I accept any and all risks associated with interpreting the information available to me.

I Agree
5.  That rowing and sailing are performed in open crafts and are physically demanding activities where there may be unusual risks to my or my child's health and safety.

I Agree
6.  That certain on-shore activities, such as carrying boats, may pose unusual risks to my or my child's health and safety.

I Agree
 7.  That my decision to participate in rowing and sailing at the Hingham Maritime Center, Inc. is made by me, on behalf of myself or my child, in full recognition of the above-mentioned risks and is entirely voluntary.

I Agree
 

 

I hereby self-certify or certify on behalf of my child as follows:

1.  That I or my child am/is in adequate physical condition to participate in rowing and/or sailing activities, and that I will notify HMC staff if I or my child have/has or if I or my child develop/develops any physical problem or health condition that may affect my or my child's ability to participate in rowing and/or sailing activities without posing a danger to my or my child's health and safety, or the health and safety of others.

I Agree
2. That I or my child am/is able to swim for at least 200 yards or 182 meters, remain afloat in deep water without external aid without risk of drowning for at least 5-10 minutes without rest between such activities, and put on a life jacket in deep water.

I Agree
3.  That I or my child have/has sufficient judgment and skill to evaluate the past, present, and future environmental conditions to determine if I or my child have/has the physical capacity to be participating in the activities/programs/classes offered by Hingham Maritime Center, Inc.

I Agree
4. That I have read and understood the contents of this document and accept the risks of operating in a maritime environment.

I Agree

 

Participant or Parent/Guardian Signature:

Date: October 29, 2020

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

Confirm Email*
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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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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