Hire a Lifeguard - Request Form

Name

First NameLast Name

E-mail

example@example.com

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please let us know your date and time requests as well as the location

Please tell us details about your event (type of event, approximate number of swimmers, age groups, etc)

Please state if any of the swimmers have any pertinent medical conditions, allergies or specific needs

Please let us know if you have any questions

I (the parent and/or legal gurdian) recognize that the program may involve physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. Activity involves an element of risk and danger of accidents, and knowing those risks, I hereby assume those risks
I (the parent and/or legal gurdian) acknowledge that my enrollment and subsequent participation is purely voluntary and is in no way mandated by ABC first aid + aquatics. In consideration of my participation in this the company and its agents from any claims, demands, and causes of action as a result of my voluntary participation and enrollment.

I hereby consent that my child/myself and those I am in the care of may participate in the Activity, and I hereby execute the above agreement, waiver, and release on his/her behalf. I hereby assert that my me/my child the those in my care are physically able to participate in said activity. I hereby agree to indemnify and hold harmless the Instructor from any loss, liability, damage, cost, or expense, which may occur as a result of death or injury, illness or property damage, that me or my child may sustain, while participating in the Activity.

I fully understand that me/my child and those in my care may injure themselves as a result of my enrollment and subsequent participation in this program and I (the parent and/or legal gurdian) hereby release ABC first aid + aquatics and its agents from any liability now or in the future for conditions that I may obtain

I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE LIABILITY AND RISK STATEMENTS

Yes

Signature - place finger or mouse here to sign