Get In & Swim LLC Emergency Contact Medical Form and Waiver
Required of all new swimmers! Swimmers may submit a new form if their info has changed.
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Email *
Email address above is used for day-of emergency cancels!
First Name *
Last Name *
Year of Birth *
Street Address *
City *
State *
Zip Code *
Preferred Telephone Contact *
Primary Emergency Contact Name *
Primary Emergency Contact Number(s) *
Relevant Medical Conditions & Medications *
I, the undersigned participant, hereby certify that I am physically fit and have not been otherwise informed by a doctor. I acknowledge that I am aware of all the risks inherent in swimming and in being in a pool or open water venue, including permanent disability and death, and agree to assume all those risks. I knowingly and freely assume all risks related to illness and infectious diseases, such as COVID-19, even if arising from the negligence or any other fault of any kind. As a condition of my participation in the Get In & Swim LLC Program or any related activities, I hereby waive any and all of my rights to claim for losses or damages, including all claims for loss or damages caused by the negligence, active or passive, of the following: Get In & Swim LLC; Swim Smooth; the host facilities; and/or any individual participating in the program as a coach, swimmer, volunteer or observer. Furthermore, I consent to the use of any images, audio, written feedback or video recordings made by Get In & Swim LLC that include myself, for their use in marketing or educational materials. *
Required
Date of Authorization *
MM
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DD
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YYYY
Authorization by Parent or Legal Guardian if Minor
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