|
Ed and Ruth
Lehman YMCA
Waiver for Swim
Team Participants
Name
____________________________________________________
Address
__________________________________________________
City
____________________________ Zip
____________________
Home Phone
_______________________________
Parent(s)/Guardians(s) Names
___________________________________
Other Emergency
Contact:
Name _________________________________________________
Phone ________________________________________________
The Ed and Ruth
Lehman YMCA will not assume responsibility for any injury incurred
while participating in any athletic events, sports program, or any
physically related activity. Certain risks are inherent
during participation in these events. Nor will the Lehman
YMCA be liable for lost or stolen items while members and/or
progream participants are using the YMCA facilities or are on the
YMCA premises. I, the undersigned for myself do hereby
release the YMCA and its employees and agents from any and all
claims for injury, death, loss, or damage i may suffer as a result
of my participation.
_________________________________________
__________________
Participant
Signature
Date
________________________________________
__________________
Parent/Guardian
Signature
Date
|
