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FRIENDS OF PHILLY AQUATICS
HARTRANFT AQUATICS EDUCATION CENTER

AQUATIC PROGRAM PARTICIPATION WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK, MEDICAL AUTHORIZATION & PHOTO RELEASE

ACKNOWLEDGMENT OF RISKS & ASSUMPTION OF RISK

I understand that participation in swimming lessons, aquatic activities, recreational swimming, water fitness, lifeguard training, aquatic workforce development programs, camps, certification courses, and related aquatic activities involves inherent and unavoidable risks that may result in serious injury, illness, permanent disability, emotional distress, property damage, or death.

ASSUMPTION OF RISK

I understand that participation in open/public swim and recreational aquatic activities involves inherent risks including serious injury, illness, permanent disability, or death.

Risks include but are not limited to:

  • Slips, falls, and collisions
  • Water-related injuries
  • Drowning or near drowning
  • Physical exertion and fatigue
  • Exposure to chemicals or pool equipment
  • Diving or jumping injuries
  • Injuries caused by other participants
  • Exposure to communicable illnesses
  • Risks associated with emergency situations
  • Injuries arising from aquatic recreational activities

I voluntarily choose to participate, or permit the minor participant to participate, with full knowledge and understanding of these risks.

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of others, except in cases of gross negligence or intentional misconduct.

RELEASE OF LIABILITY & WAIVER OF CLAIMS

In consideration for being permitted to participate in programming operated by Friends of Philly Aquatics and/or conducted at Hartranft Aquatic Education Center, I, on behalf of myself, the participant, my heirs, assigns, personal representatives, and next of kin, hereby release, waive, discharge, and covenant not to sue:

  • Friends of Philly Aquatics
  • Philadelphia Housing Authority
  • Hartranft Aquatic Education Center
  • Program instructors
  • Lifeguards
  • Water Safety Instructors
  • Coaches
  • Employees
  • Volunteers
  • Contractors
  • Partner organizations
  • Sponsors
  • Facility owners/operators
  • The City of Philadelphia and affiliated departments/agencies where applicable

(collectively referred to as the “Released Parties”)

from any and all liability, claims, demands, losses, damages, causes of action, costs, or expenses arising out of or related to participation in aquatic activities, including claims alleging ordinary negligence.

This release applies to personal injury, illness, disability, death, property damage, and any other losses sustained during participation, transportation, facility use, or presence on the premises.

INDEMNIFICATION & HOLD HARMLESS AGREEMENT

I further agree to indemnify, defend, and hold harmless the Released Parties from and against any and all claims, liabilities, damages, costs, expenses, or attorney’s fees arising from or related to the participant’s actions, conduct, or participation in programming.

I understand and agree that this agreement is intended to be as broad and inclusive as permitted under the laws of the Commonwealth of Pennsylvania.

If any portion of this agreement is held invalid, the remaining portions shall continue in full legal force and effect.

MEDICAL AUTHORIZATION & EMERGENCY CARE CONSENT

I certify that the participant is physically capable of participating in aquatic activities unless otherwise disclosed in this form.

I authorize Friends of Philly Aquatics staff, instructors, lifeguards, emergency personnel, or authorized representatives to provide or obtain emergency medical treatment if deemed necessary.

This authorization includes:

  • First aid
  • CPR/AED assistance
  • Emergency transportation
  • Hospitalization
  • Medical evaluation and treatment

I understand that reasonable efforts will be made to contact the parent/guardian or emergency contacts listed above.

I accept responsibility for all medical expenses incurred.

I understand that my personal medical insurance shall serve as the primary coverage source.

PARTICIPANT CONDUCT, FACILITY, & LOCKER ROOM RULES ACKNOWLEDGMENT

I acknowledge and agree to follow all facility rules and staff instructions, including but not limited to the following:

  • WAIVER REQUIRED before entry.
  • NO SWIMMING without a lifeguard on duty.
  • SHOWER before entering the pool.
  • No running, pushing, rough play, dunking, disrespect, or profanity.
  • No diving or breath-holding contests.
  • Food, glass, vapes, cigarettes, bicycles, skateboards, and chairs are prohibited.
  • Alcohol, drugs, and weapons are strictly prohibited.
  • Proper swim attire is required.
  • No denim, street clothing, or undergarments in or under swimwear.
  • No sneakers in the water.
  • Men’s swimsuits must contain mesh lining.
  • Swim diapers required for non-toilet-trained children.
  • Follow all lifeguard instructions immediately.
  • No electronic devices including cell phones, tablets, or iPads may be used in restricted aquatic areas.
  • Swimmers may be required to complete a swim competency test for deep water access.
  • Access to deep water features may require successful completion of a swim competency test administered by aquatic staff.Failure to comply may result in removal from the facility.


Locker Room Rules

  • NO CAMERAS OR RECORDING DEVICES permitted in the locker rooms.
  • Children under 8 must be accompanied by an adult.
  • Secure valuables with a personal lock. The facility is not responsible for lost or stolen items.
  • No food or glass containers permitted in the locker rooms.
  • No horseplay, fighting, or jumping from benches.
  • Adults must not undress in the presence of minors. Please use designated changing stalls.
  • Please be respectful and efficient while showering and changing. Do not spend excessive time in the showers or locker room areas.
  • Respect the privacy of others. Keep your eyes to yourself, do not make comments about other individuals, and do not engage others in uncomfortable or inappropriate conversations while showering or changing.
  • Locker rooms must be vacated when the pool closes. Please plan accordingly to finish showering and changing before closing time.
  • Items left overnight will be removed.

I understand that unsafe, disruptive, threatening, aggressive, or non-compliant behavior may result in removal from activities or suspension from programming without refund.

CHILD SUPERVISION POLICY

I acknowledge and understand the following supervision requirements:

  • Children under 8 years old must be accompanied by a responsible adult.
  • Children under 12 years old may not be left unattended at the facility.
  • Non-swimmers require active adult supervision regardless of age.
  • Parents/guardians may be required to remain in the water with children who cannot swim independently.

SPECTATOR & DECK ACCESS POLICY

I understand and acknowledge that:

  • Deck access may be restricted to swimmers, staff, instructors, approved volunteers, and authorized individuals only.
  • Spectators, parents, and visitors may be limited to designated viewing or waiting areas.
  • During high-capacity operations, programming, or emergencies, staff may restrict or deny deck access for safety and operational reasons.
  • Unauthorized individuals may be removed from restricted areas at staff discretion.

HEALTH & COMMUNICABLE ILLNESS ACKNOWLEDGMENT

I agree that the participant will not attend programming if experiencing symptoms of contagious illness including fever, vomiting, diarrhea, rash, or other symptoms that may place others at risk.

I understand that participation in group activities may involve exposure to communicable illnesses despite reasonable safety measures.

AMERICAN RED CROSS PROGRAM ACKNOWLEDGMENT

I understand that programming may incorporate instructional standards, safety guidance, or curriculum associated with the American Red Cross Learn-to-Swim and aquatic safety programs.

Participation does not guarantee certification unless all required standards and competencies are successfully completed.

AUTHORIZATION & ACKNOWLEDGMENT

I acknowledge that I have carefully read and fully understand this agreement and voluntarily agree to its terms.

Date: September 5, 2026

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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:*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
Health & Safety Disclosure
Do you have any medical conditions, injuries, physical limitations, or health considerations that may affect your safe participation?*
No
Yes
If you selected 'yes' to the Health and Safety Question above, please explain
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*
Date of Birth
Information
Program Name:
Session/Dates:
Age:

Secondary Emergency Contact

Name:
Relationship to Participant:
Phone Number:

MEDICAL INFORMATION


Please list any allergies, medical conditions, physical limitations, medications, disabilities, behavioral concerns, or accommodations staff should be aware of:
Participant’s Physician:
Physician Phone Number:
Medical Insurance Provider:
Policy Number:

PHOTO, VIDEO & MEDIA RELEASE (OPTIONAL)

YES — I GRANT PERMISSION

I authorize Friends of Philly Aquatics, Hartranft Aquatic Education Center, affiliated partners, sponsors, and program representatives to photograph, videotape, interview, or otherwise record the participant’s image, likeness, voice, and participation for lawful educational, promotional, marketing, social media, fundraising, public relations, grant reporting, archival, and outreach purposes

I understand:

● No compensation will be provided.

● Media may be used in print, digital, video, website, social media, or broadcast format.

● I waive the right to inspect or approve final materials.

NO — I DO NOT GRANT PERMISSION
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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