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Students entered below will be added to your family's account
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Infomed Consent & Waiver
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I, the undersigned, as the parent/legal guardian of the child(ren) listed on this form agree and understand that swimming is a hazardous activity, and I recognize there are risks inherent in the sport of swimming, including, but not limited to, paralyzing injuries and death. In registering my minor child(ren) to participate in Atlantis Swim Academy, LLC swim lessons, programs, and/or events, I am agreeing to indemnify and hold harmless Atlantis Swim Academy its instructors, officers, directors, agents, and employees against any liability resulting from any injury that may occur to my child(ren) while participating in Atlantis Swim Academy, LLC swim lessons, programs, or events. I also agree to indemnify Atlantis Swim Academy, LLC for any damages incurred arising from any claims, demand, action, or cause of action by my child(ren). Atlantis Swim Academy, LLC assumes no responsibility for any personal property placed in or about the facility. As the parent/guardian, I authorize any representative of Atlantis Swim Academy, LLC to have my child(ren) treated in any medical emergency during their participation in Atlantis Swim Academy, LLC swim lessons, programs, or events. Further, the participant and/or parent/guardian agrees to pay all costs associated with medical care and emergency transportation for the participant.
I've read the above and agree.
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Photos and/or Video Release
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I also understand that photos and/or video are occasionally taken at Atlantis Swim Academy, LLC, and any photo and/or video taken of my child(ren) may be used for Atlantis Swim Academy, LLC publicity and promotional purposes. I hereby grant permission to Atlantis Swim Academy, LLC to use, edit, and reuse my child(ren)'s photograph or likeness in any publicity or promotional media materials including use in print, on the Internet, and all other forms of media. I also hereby release Atlantis Swim Academy, LLC and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.
I've read the above and agree.
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Other Questions/Comments: |
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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Card Expiration Month: * |
Exp Year: *
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City:
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State:
Zip:*
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