Liability Waiver
Thank you for joining AQUAFit at Lakehead University CJ Saunders Fieldhouse Pool.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Disclaimer: AQUAFit Instructors Anne Parr and hosting facility Lakehead University CJ Saunders Fieldhouse accept no responsibility for any damages, injuries, or consequences resulting from the actions of people, including Instructors and trainees engaged in AQUAFit training, however caused. Individuals participating in AQUAFit / or using exercises or techniques shown, now or in future, do so at their own risk. Informed Consent: I, (print your name) ___________________________ acknowledge that there is the risk of injury or death associated with participating in any physical activity including exercises and techniques used in AQUAFit session, and I assume all such risks. I release Anne Parr Instructor, Lakehead University Pool Facilitators, and the hosting facility Lakehead University CJ Saunders Fieldhouse from any liability for damages or claims arising out of any loss or injury sustained by myself during or following participation in any demonstrations or training activities, whether or not the Instructors, Facilitators, Trainers, Trainees, Volunteers, or facility staff holding this event are negligent. Please put your initials in each box below to acknowledge that you have read each statement and accept full responsibility for your participation and actions during this training course.
*
By reading this, I am being informed, and am aware that aquatic exercises and procedures, including the use of equipment, involve a risk of loss or injury, and that I am voluntarily participating in these activities and using equipment at my own risk. I agree that if I feel light headed, dizzy, nauseous, or experience pain or discomfort at any time during the training event, I will immediately inform anyone working with me, including the Instructor, facility staff / lifeguard, and will stop the activity immediately. I agree to inform the event Instructor, and anyone I am working with at any time while participating in AQUAFit, of any existing conditions or changes in my health that might affect my ability to participate safely and with minimal risk of injury. I understand that I am not obliged to perform or participate in any activity prescribed unless I wish to do so. I know that I have the right at any time to decline or stop participation in any exercise, activity, or demonstration. I understand that videos and / or still pictures containing my image during on-site training may be used in future training literature, promotional materials to advertise class. I grant my consent for unrestricted use of all such imagery. I understand that I will not be compensated now, or in future, for use of my image in these materials I acknowledge that I have read and fully understand the Disclaimer and Informed Consent presented on this page. My signature indicates my understanding and full agreement with all terms and conditions stated here. For participants younger than age of majority, signature of parent or guardian is required as witness
Waiver
Signature
blanks
field.
Under 18 Witness / Signature of guardian
blank
fields and text.
Save
Submit
Should be Empty: