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2023 Blue Journey Unified Team Annual OCSC Member


In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that: 

  1. The risk of injury from the activities involved in this program is significant, including the potential for per- manent paralysis and death. 
  2. 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 partic- ipation. 
  3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual signifi- cant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately. 

Waiver: I the undersigned participant, intending to be legally bound, hereby certify that I am physically fit and have not been otherwise informed or instructed by a physician to avoid physical activities and specifically those falling into categories undertaken through my participation in this and other club events. This acknowledgement is in recognition of my planned participation in club events for up to 12-months with the understanding that I am responsible for notifying club and event hosts or organizers of any new instructions provided to me by a physician that would impact my ongoing and safe participation in club events.  I acknowledge that I am aware of all the risks inherent in Pool, Ocean and Open Water swimming, paddling and similar recreational activities and sports (training and competition) including the possible permanent disability or death and agree to assume all of those risks. AS A CONDITION OF MY PARTICIPATION IN THE SWIMMING PROGRAM OR ANY ACTIVITIES INCIDENT THERETO, I HEREBY WAIVE ANY AND ALL RIGHTS TO CLAIMS FOR LOSS OR DAMAGES, INCLUDING ALL CLAIMS FOR LOSS OR DAMAGES CAUSED BY THE NEGLIGENCE, ACTIVE OR PASSIVE, OF THE FOLLOWING: THE BRUCKNER CHASE OCEAN POSITIVE FOUNDATION AND IT'S PARTNERS, HOST FACILITIES, LOCAL GOVERNMENT AGENCY, EVENT AND TEAM SPONSORS, EVENT COMMITTEES, OR ANY INDIVIDUALS PROVIDING LIFEGUARD SERVICES, OFFICIATING OR SUPERVISING ACTIVITIES. In addition, I agree to abide by and be governed by all safety rules of the local hosts, local support agencies, local government agencies and Bruckner Chase Ocean Positive, Inc staff as shared, verbally provided or posted while acknowledging that these guidelines may be changed due to variable conditions in the venues where activities will take place. I agree to abide by ALL instructions from the onsite supervisors coaches and lifeguards and will follow those instructions immediately for my own safety and the safety of others. I further agree to allow any photographic or video images to be used for promotion of the club's and Ocean Positive, Inc's mission and message on ocean and community safety, well-being, capacity building, conservation and fitness.



Athletes, Volunteers, Coaches, Lifeguards
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First Annual Members Name

First Name*

Last Name*

Phone*
First Annual Members Date of Birth*
First Annual Members Emergency Information

Emergency Contact Name *

Emergency Contact E-mail *

Emergency Contact Phone Number w Area Code *

Emergency Contact Relationship to Member / Participant *
First Annual Members Signature*
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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Mobility
Please provide information on your mobility by selecting the most appropriate response*
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Emergency Information

Emergency Contact Name *

Emergency Contact E-mail *

Emergency Contact Phone Number w Area Code *

Emergency Contact Relationship to Member / Participant *
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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