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Swimming Wavier

Kim Tam Park at Melanie Springs Waiver and Release of Liability

Release of Liability, Waiver of Claims, Assumption of Risk, and Indemnity Agreement

PLEASE READ CAREFULLY. BY SIGNING THIS DOCUMENT, YOU CHOOSE TO WAIVE

CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO BRING A LAWSUIT.

To: Kim Tam Park at Melanie Springs (aka Melanie Lake, Inc. & 2881 Canton Rd. Trust dated

4/16/2018) (Owner of Property, Releasees)

I wish to be on the property of Owner and swim at the park’s natural spring fed lake facilities. By

doing so, I recognize and fully understand certain things, including:

• I (the Participant) am responsible for all persons under the age of 18 which have accompanied

me to the park;

• I am responsible for my own actions and will not be in the water if a lifeguard is not on duty;

• I will follow all instructions and orders of the lifeguards;

• My use of the swimming facilities during my stay involves certain risks, including but not

limited to:

1) The risk of drowning and my participation in swimming activity is at my own risk;

2) The risk of injury resulting from possible malfunction of equipment (eg. diving board,

ladders, etc.);

3) The risk of injuries resulting from tripping or falling over obstacles;

4) The risk of injuries resulting from unsupervised divers and swimmers colliding;

5) The risk of other injuries resulting from participating in any action in the lake.

• I recognize and fully understand that the above list is not a complete or exhaustive list of all

possible risks; the list only provides examples of types of risks that I am assuming.

In exchange for the Owner allowing me to utilize the park and swimming facilities during my stay, I

hereby agree to the conditions below. I fully intend and choose to give up the legal rights, as stated

below:

1) TO WAIVE ANY AND ALL CLAIMS that I have or may have in the future against the Owner,

its directors, officers, employees, agents, or representatives (hereinafter referred to as the

“Releasees”) relating to my use of the park and lake;

2) TO RELEASE THE RELEASEES from any and all liability for any loss, damage, injury,

expense, or other cost that I may suffer or that my next of kin may suffer in connection with

my use of the Releasees park and/or lake area to any cause whatsoever, INCLUDING

NEGLIGENCE ON THE PART OF THE RELEASEES;

3) TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability to

property, or personal injury to, any third party, resulting from the use of the park or lake area


4) That this Waiver, Release, and Agreement is fully effective and shall be effective and binding

upon me, and my heirs, next of kin, executors, administrators, and assigns, or anyone else

authorized to act on my behalf or on behalf of my estate.

I have read and understood this document. I am aware that by signing this document, I am waiving

certain legal rights that I may have against the Releasees, and I fully agree to do so.

**IF PARTICIPANT IS LESS THAN 18 YEARS OF AGE, THE PARENT OR LEGAL GUARDIAN

OF THE PARTICIPANT MUST SIGN BELOW**



First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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Swimming Ability
Is there anyone in your group that is not a strong proficient swimmer?*
No
Yes

**I am the parent or legal guardian of the Participant named above; I have read and understand the

foregoing Release of Liability, Waiver of Claims, Assumption of Risk, and Indemnity Agreement

(including such parts as may subject me to personal financial responsibility); I am and will be legally

responsible for the obligations and acts of the Participant as described 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*
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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