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WeLifeguard Swimming Lessons Request/Consent & Waiver Form

For Lifeguard Directory





Informed Consent and Waiver/ Release Form

Please read this form carefully before signing. This form is a release of liability and waiver of certain legal rights.

I Agree

You acknowledge, and agree that the use of WeLifeguard's directory is at your sole and exclusive risk. You agree that you knowingly and freely, assume all risks, both known and unknown, including all injuries or damages that may arise from using the directory or the services provided to you from a lifeguard on the directory. In no event will WeLifeguard or any of its officers, directors, members, managers or other representatives be liable to you for any indirect, special, incidental, or consequential damages, or for any other losses or expenses that arise out of the use of WeLifeguard's directory or the services provided to you from a lifeguard on the directory.

I Agree

WeLifeguard is a nonprofit directory of lifeguards. You, the homeowner, hire and pay the lifeguard or swim instructor directly.  

I Agree

There are risks inherent in the activities by lifeguards and swim instructors listed on the WeLifeguard directory. These activities may be of a hazardous nature and/or may include activities such as swimming, swimming lessons, diving, and lifeguarding. In no event will WeLifeguard be liable for any damages arising out of or relating to the conduct of you or anyone else in connection with WeLifeguard’s services including but not limited to bodily injury, death, paralyzing injuries, and brain injuries. You are responsible for any accident, illness, injury, or death of any person or persons, or damage to or loss or destruction of any property arising or resulting from swimming, swimming lessons, diving, and/or lifeguarding directly or indirectly from your son(s)/daughter(s), friends, guests, invitees, and/or relatives participation in the aforementioned activities and occurring during said participation or any time subsequent thereto while such activities are being conducted at your request and direction. WeLifeguard shall not be liable for any damages related to, in connection with, or otherwise resulting from any use of the WeLifeguard directory of lifeguards, regardless of the negligence (either active, affirmative, sole, or concurrent) of WeLifeguard, even if WeLifeguard has been advised of the possibility of such damages.

I Agree

WeLifeguard does not guarantee the quality, suitability, safety, or ability of any lifeguard hired directly by you. You are solely responsible for evaluating the suitability and certifications of the lifeguards or swimming instructors for the services they offer to provide. You agree the entire risk arising out of your use of the WeLifeguard directory, and any service provided in connection therewith, remains solely with you. WeLifeguard shall not be liable for any transaction or relationship between you and any hired lifeguard, or any transaction or relationship between you and any lifeguard. You agree to indemnify and hold WeLifeguard harmless for any acts or omissions.

I Agree

You further agree that any claim for injuries or damage shall solely be submitted to your own insurance company and that you shall be the sole source of any damages arising out of any and all services provided to you by WeLifeguard. You further agree to provide defense counsel for WeLifeguard in the event any claim is brought against WeLifeguard or any lifeguard, arising out of your hosted pool event or swimming lessons.

I Agree

CHOICE OF LAW: You understand and agree that the laws of the State of Connecticut will apply to this contract, and any dispute will be resolved by arbitration. If any provision of this Waiver and Release of Liability is declared invalid, the remaining provisions remain enforceable. You have had sufficient time to read this entire document and, should you choose to do so, consult with legal counsel prior to signing. By signing this Waiver and Release of Liability, you acknowledge that either you have sought the advice of legal counsel or wish to waive the opportunity to seek the advice of counsel before signing. Any dispute must be resolved in an arbitration.  

I Agree

YOU HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE YOUR RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE: 

 

October 2, 2023



First Homeowner Name

First Name*

Middle Name

Last Name*

Phone*
First Homeowner Date of Birth*
I certify that I am 18 years of age or older
First Homeowner Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
First Homeowner Signature*
Second Homeowner Name

First Name*

Middle Name

Last Name*
Second Homeowner Date of Birth*
Second Homeowner Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
Third Homeowner Name

First Name*

Middle Name

Last Name*
Third Homeowner Date of Birth*
Third Homeowner Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
Fourth Homeowner Name

First Name*

Middle Name

Last Name*
Fourth Homeowner Date of Birth*
Fourth Homeowner Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
Fifth Homeowner Name

First Name*

Middle Name

Last Name*
Fifth Homeowner Date of Birth*
Fifth Homeowner Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
Sixth Homeowner Name

First Name*

Middle Name

Last Name*
Sixth Homeowner Date of Birth*
Sixth Homeowner Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
Seventh Homeowner Name

First Name*

Middle Name

Last Name*
Seventh Homeowner Date of Birth*
Seventh Homeowner Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
Eighth Homeowner Name

First Name*

Middle Name

Last Name*
Eighth Homeowner Date of Birth*
Eighth Homeowner Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
Ninth Homeowner Name

First Name*

Middle Name

Last Name*
Ninth Homeowner Date of Birth*
Ninth Homeowner Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
Tenth Homeowner Name

First Name*

Middle Name

Last Name*
Tenth Homeowner Date of Birth*
Tenth Homeowner Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
Parent or Guardian's Email Address

Email*

Confirm Email*
Safety Information

PLEASE understand, swim instructors aren't babysitters. Toddlers can't be left without parent supervision poolside.

Filling out this form is not a guarantee that a swim instructor will be available for your event.




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*

Middle 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 Required Information

Email Address *

Home/Event Address *

Age of participant

Swimming level of participant

May we thank someone for referring you?
Have you previously used the Directory?*
No
Yes
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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