Loading...

Adventure Sports Unlimited

Waiver/Release for Swim Participation

303 Potrero St Suite 15

Santa Cruz, Ca 95060

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT In consideration of being allowed to participate on behalf of Adventure Sports Unlimited athletic program and related events and activities, the undersigned acknowledges, appreciates, and agrees that: 

1. Participation includes possible exposure to and illness from infectious diseases including but not limited to 

MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 

2. I, MYSELF AND/OR CHILDREN, WILL NOT COME TO CLASS IF ANYONE IN THE HOUSEHOLD HAS A FEVER, RUNNY NOSE OR COUGH; and, 

3. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

4. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If I, however, observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

5. People considered to be at a higher risk for contracting illnesses should not participate in such activities where a communicable illness may be present and therefore will require a medical statement signed by a licensed physician; and,

  • a. I acknowledge being considered “high risk” are those people with chronic lung disease or moderate to severe asthma, have serious heart conditions, severe obesity (body mass index [BMI] of 40 or higher), with diabetes, chronic kidney disease undergoing dialysis, liver disease, or are immunocompromised (Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications).

6. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Adventure Sports Unlimited their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

7. In consideration of your acceptance for enrollment in the Adventure Sports Unlimited Swim Program, I, my heirs, executor and administrator agree to aware and understand that activities involving Swimming/ SCUBA/ Snorkeling are dangerous and involve risk of drowning, serious injury and/or death. I acknowledge that I am voluntarily participating in the activities with the knowledge of the dangers involved and hereby accept and assume any and all risks of injury including death, even if arising from the negligence of the releasees.

8. I expressly waive and release any and all claims against Adventure Sports Unlimited and its owners, managers, officers, employees, agents, affiliates, successors, and assigns (collectively, releases), on account of injury or death arising out of or attribute to my participation in the activities. Whether arising out of the negligence of the Adventure Sports Unlimited or any releases or otherwise. I covenant not to make or bring any such claim against Adventure Sports Unlimited or any other release and forever release, discharge and hold Adventure Sports Unlimited and other releases harmless from liability under such claims.

9. I hereby authorize any representatives of Adventure Sports Unlimited to have the participant treated in any medical emergency during his/her participation in the activities. Further, the participant and/or parent/guardian agrees to pay all costs associated with medical care for and transportation of the participant. I have notified Adventure Sports Unlimited of any medical/health problems of which the Adventure Sports Unlimited’s staff should be aware prior to participating in the Swim Program.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. 

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION) 

This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.

First Participant's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Emergency Contact's Name*

Emergency Contact's Phone Number*
Allergy and/or Medical Conditions

Name and Condition

Name and Condition

Name and Condition
Program Payment and Billing
I understand that all fees are due by the first day of the session. *
I agree
I understand that if I cancel my child's swim class before they are scheduled, a refund will be issued. If I cancel my child's swim class after they have been scheduled, a credit will issued for future use. If Adventure Sports cancels classes due to COVID related safety precautions, a credit for missed days will be issued for future use. *
I agree
Image release
In consideration of participation in the Adventure Sports Unlimited Swim Program, the undersigned agrees that their likeness, or the likeness of their child/ward may be photographed or videotaped and that such image may be published in an outlet used to promote or publicize the sports program.*
Yes
No
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*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!