801 Visiting Swimmer Release Form

VISITING SWIMMER RELEASE

Competitive Program Practices - MAX visitation is 7 swim practices unless special permission has been approved by FCST's Head Coach.
Visitation Start Date*

MonthDayYear
Date
Visitation End Date*

MonthDayYear
Date
REASON FOR YOUR VISIT*

Swimmer under 18 looking to transfer from another clubSwimmer under 18 visiting from out of townCollege student visiting during summer break (age 18))College student visiting during winter break (age 18)Other
CURRENT CLUB/TEAM NAME*
If not applicable, enter "N/A"
CITY/STATE LOCATION OF CURRENT CLUB/TEAM *
If not applicable, enter "N/A"
SWIMMER INFORMATION & PROOF OF USA SWIMMING MEMBERSHIP

Required for all adult and minor visiting swimmers
Name*

(Legal First Name)(Middle Name)(Last Name)
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
DATE OF BIRTH*

MonthDayYear
Date
Age at the time of visitation*
USA Membership ID No.*
USA SWIMMING ATHLETE MEMBERERSHIP EXP DATE*

MonthDayYear
USA Non-Athlete membership MUST be current.
***IMPORTANT***

Per USA Swimming Rules and MAAPP, if you are 18, your membership card must show valid membership status and valid completion of the SafeSport Athlete Protection Training (APT).
UPLOAD VALID USA SWIMMING MEMBER ID (Screenshot of SWIMS ID Card)*

Visiting Swimmers must provide proof of valid USA Swimming Athlete Membership
Cancelof

PARENT/GUARDIAN INFORMATION

Only required for visiting minor competitive swimmers
Parental or Legal Guardian Relation to swimmer*
Select "Not Applicable" if you are the eligible adult swimmer.
First Name*
If not applicable, please enter N/A
Last Name*
If not applicable, please enter N/A
Best contact phone number
This number will be used in case of an emergency
Email
example@example.com
EMERGENCY CONTACT INFORMATION

Required for adult and minor swimmers
Emergency Contact Name and relation to swimmer*
This person will be contacted in case of emergency
Emergency Contact Number*
This phone number will be used in case of an emergency

CONSENT TO PARTICIPATE
I hereby certify and represent that (i) I am (or my Minor Athlete is) in good health and in proper physical condition to participate in practices and/or events hosted by FIRST COLONY SWIM TEAM (FCST); and (ii) I have not been advised of any medical conditions that would impair my ability (or my Minor Athlete's ability) to safely participate in practices and/or events hosted by FIRST COLONY SWIM TEAM (FCST).

I agree that it is my sole responsibility to determine whether I am (or my Minor Athlete is) sufficiently fit and healthy enough to participate in the swimming practices, competitions, meets or events.

I acknowledge the inherent risks associated with the sport of swimming. I understand that my (or Minor Athlete's) participation involves risks and dangers, which include, without limitation, the potential for serious bodily injury, sickness and disease, permanent disability, paralysis and death (from drowning or other causes); loss of or damage to property and equipment; exposure to extreme conditions and circumstances; accidents involving other participants, staff members, coaches, volunteers or spectators; contact or collision with natural or manmade objects; dangers arising from adverse weather conditions; imperfect water conditions; water and surface and subsurface hazards; facility issues; equipment failure; inadequate safety measures; participants of varying skill levels; situations beyond the immediate control of FIRST COLONY SWIM TEAM; and other undefined, not readily foreseeable and presently unknown risks and dangers (“Risks”). I understand that these Risks may be caused in whole or in part by my (or my Minor Athlete's) own actions or inactions, the actions or inactions of other participants or third parties or the negligent acts or omissions of the Released Parties defined below, and I hereby expressly assume all such Risks and responsibility for any damages, liabilities, losses or expenses that I (or my Minor Athlete) may incur as a result of my, or my child’s participation in practices, competitions, meets and/or events hosted by FIRST COLONY SWIM TEAM (“FCST”), or third parties.

I agree to that I will (or my Minor Athlete will) be familiar with and abide by the Rules and Regulations established by FIRST COLONY SWIM TEAM and USMS, including any safety regulations. I accept sole responsibility for my and/or my Minor Athlete's conduct and actions while participating in practices and events.

I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I (or my minor child) may be exposed to or infected by COVID-19, or other viral or bacterial infection, while participating in any practices and/or events hosted by FIRST COLONY SWIM TEAM, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I agree that if I (or my minor child) have/has a fever, cough, feel short of breath, have any other symptoms, have knowingly been exposed to a communicable disease such as COVID-19 I agree not to participate in FCST's Non-Competitive, Auxiliary Programs for a minimum of 10 days from the date the symptoms started, until the symptoms have subsided or I have been cleared by a doctor. If I test positive for COVID-19 within 10 days following participation in practices and/or events hosted by FCST, I will notify a member of FCST's coaching or administrative staff immediately.
Authorized Signer relation to visiting swimmer*
Printed name of authorized signer *
First and last name of either the eligible adult swimmer (age 18+) OR parent OR legal guardian minor.
Signature of authorized signer*

Clear
Today's Date*

MonthDayYear
Date

MEDICAL RELEASE
IN THE EVENT OF ACCIDENT, INJURY, ILLNESS. I HEREBY GIVE MY PERMISSION FOR ANY SUPERVISOR, COACH OR OTHER AGENT OR ADMINISTRATOR ASSOCIATED WITH FIRST COLONY SWIM TEAM TO SEEK AND GIVE APPROPRIATE MEDICAL ATTENTION TO MYSELF OR MY CHILD ENROLLED IN FCST SWIMMING PROGRAMS.

I ACKNOWLEDGE AND AGREE TO BE FINANCIALLY RESPONSIBLE FOR ANY AND ALL COSTS ASSOCIATED WITH ANY NECESSARY MEDICAL ATTENTION AND/OR TREATMENT.

BE IT FURTHER KNOWN THAT I HEREBY RELEASE ANY LICENSED HEALTH CARE PROVIDER PROVIDING MEDICAL CARE TO MY MINOR ATHLETE.

I hereby represent and warrant that I am of legal age and competent to enter into this Consent, that I have read this Consent carefully, understand its terms and conditions, acknowledge that I will be giving up substantial legal rights by signing it (including the rights of my spouse, children, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors, and assigns), acknowledge that I have signed this Consent without any inducement, assurance, or guarantee, and intend for my signature to serve as confirmation of my complete and unconditional acceptance of the terms, conditions and provisions of this Consent. This Consent represents the complete understanding between the Me and FCST regarding these issues and no oral representations, statements, or inducements have been made apart from this Consent. If any provision of this Consent is held to be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Consent and shall not affect the validity and enforceability of any remaining provisions.
Authorized Signer relation to visiting swimmer*
Printed name of authorized signer *
First and last name of either the eligible adult swimmer (age 18+) OR parent OR legal guardian minor.
Signature of authorized signer*

Clear
Today's Date*

MonthDayYear
Date

Indemnity Waiver & Release
INDEMNITY WAIVER & RELEASE

I hereby Release, Waive and Covenant Not to Sue, and further agree to Release, Indemnify, Defend and Hold Harmless the following "released parties:

FIRST COLONY SWIM TEAM (including, but not limited to) any Officers and Directors of the Board, employees, members, program directors, coaching staff, agents, independent contractors, advisors, volunteers, or any other FCST representatives providing support for FCST's Non-Competitive, Auxiliary Program practices and hosted events and competitions or meets (individually and collectively, the “Released Parties”), with respect to any liability, claim(s) (including, third party claims), demand(s), cause(s) of action, damage(s), loss or expense (including court costs and reasonable attorneys’ fees) of any kind or nature (“Liability”) which may arise out of, result from, or relate in any way to my participation (or my child) in practices, competitions, meets or events, including claims for Liability caused in whole or in part by the negligent acts or omissions of the Released Parties.

I further agree that if, despite this Consent / Indemnify / Waiver / Release, I, or anyone on my behalf, makes a claim for Liability against any of the Released Parties, I will indemnify, defend and hold harmless each of the Released Parties from any such Liabilities which any may be incurred as the result of such claim.
Authorized Signer relation to visiting swimmer*
Printed name of authorized signer *
First and last name of either the eligible adult swimmer (age 18+) OR parent OR legal guardian minor.
Signature of authorized signer*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

VISITING SWIMMER RELEASE

SWIMMER INFORMATION & PROOF OF USA SWIMMING MEMBERSHIP

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

CONSENT TO PARTICIPATE

MEDICAL RELEASE

Indemnity Waiver & Release