I _____________________________, understand that there are inherent risks associated with activities around a swimming pool and, more specifically, with the program offerings of LSI, Inc., and that prior to beginning any program involving physical exertion, the participant (I/my child) should obtain medical clearance from a physician. I understand that medical emergencies, injuries and complications can occur as a result of strenuous physical associated with swimming, swimming pools and LSI, Inc. such as: the pool, changing rooms, common areas, equipment in and out of the pool building, steps, parking lot and surrounding areas. The risks include but are not limited to: ear and eye infections, colds, abrasions, cuts, nosebleeds, burns, stings, rashes, head injuries, injured or broken limbs, paralysis and even death. I know that the pool at LSI is 3.5-10 ft deep. I voluntarily consent to attend or participate or have my child/children attend or participate in activities at LSI, Inc. I further release LSI and its leaders, employees, and volunteers from any claim that my child or children, I am responsible for, myself or anyone entering the pool presises that I have invited, whether that be friend, nanny, relative, etc. may have against them as a result of injury or illness incurred, while on LSI premises. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims that members of the child's or my family, friends or caregivers, or estate, heirs, representatives, or assigns may have against LSI and its leaders, employees, and volunteers. I knowingly and voluntarily waive any and all rights and causes of action, suits, damages and claims which I may have against LSI, Inc. and instructors, employees, owners thereof, in connection with or from participation in such above-described activity and or siblings waiting to swim or children I am responsible for, along with myself or people I have invited to come watch including grandparents and nanny's, while I am on LSI's property.
By signing this form, I declare that:
- I agree to inform LSI of any changes in my health, or medical condition.
- I declare that I have read, understood, and agree to the contents of this informed
consent agreement in its entirety.
- I understand full payment is due the first week of class or I will be charged $5.00
each week afterwards.
- I understand that the failure to follow rules and policies will result in loss of
privileges at LSI.
- I also expressly assume all risks of all children I am responsible for bringing on LSI
premises, whether such risks are known or unknown to me at this time.
-I also expressly assume all risks of entering LSI property, being a pool building I need to
wear appropriate shoes. along with everyone I invite and make sure they are able to walk
around a pool deck without slipping.
-I knowingly and voluntarily waive any and all rights and causes of action, suits, damages
and claims which I may have against LSI, Inc. and instructors, employees, owners thereof,
in connection with or from participation in such above-described activity and or siblings
waiting to swim or children I am responsible for, along with myself or people I have invited
to come watch including grandparents and nanny's, while I am,( they are) on LSI's property.
- I and those in my care and people I invite will comply with all LSI Pool Rules.
- LSI reserves the right to request anyone to leave the facility for failure to comply
with the above mentioned guidelines.