Kidder County Swimming Pool Waiver Release Form

PLEASE READ CAREFULLY THE CONTENTS OF THIS FORM BEFORE SIGNING.

I hereby confirm that ALL SWIMMERS are in good physical condition and do not suffer from any disabilities or physical conditions that places me or others at risk or otherwise should prohibit their participation in this event.

I am aware that the use of the KCSP involves inherent risks, including but not limited to water related injury from falling, colliding, or improper use, and I voluntarily assume all risks related to my participation.

In consideration of being permitted to use the KCSP, I hereby release, waive, discharge, and covenant not to sue the Organization, its owners, employees, agents, and representatives from any and all claims, liabilities, damages, or expenses, including but not limited to personal injury or property damage, arising from or related to my use of the KCSP except where such injury or damage is caused by the gross negligence or willful misconduct of the Organization.

In the event of an injury or medical emergency, I authorize the Organization to seek medical treatment or assistance on my behalf or on behalf of any minor under my care.

Kidder County Swimming Pool POOL RULES AND REGULATIONS

Rules of conduct at the pool are based on safety first.
Children aged 8 years of age or younger must be accompanied by someone 16 years of age or older. The supervising individual must always be with the child(ren), no exceptions.If parents would like to have their child’s swimming ability tested, they can contact the pool manager to set up a time for testing.
Only individuals 8 years old and younger who have passed the competency
swimming test will be allowed at the pool without someone 16 years of age or older.
Do not enter the pool if you have a communicable disease or open cut.
Food and beverages are NOT allowed in the pool or on the pool deck.
Glass bottles and containers are prohibited in the pool and on the pool deck.
Pool patrons must shower before entering the pool and after the use of toilet facilities.
Rough play such as dunking, pushing, chicken fights are prohibited.
No running is allowed on the pool deck or in the locker rooms.
Animals are not allowed in the aquatic’s facility.
Persons under the influence of alcohol or any judgement-impairing substances will not be admitted to the facility.
Smoking or vaping is not allowed anywhere in the aquatic’s facility.
Swim masks/goggles are allowed in the pool.
Only one individual on the diving board at a time.
Kidder County Swimming Pool/Board is not responsible for lost, damaged or stolen items.
Only authorized personnel are allowed in the pool office area.
Concessions are not free to employees or patrons of the pool, if concessions are not paid for at any time this will be considered theft.
Lifeguards and other authorized personnel are the only individuals allowed on the lifeguard platform/chairs.
Lifeguards are not to be socializing with patrons while in the lifeguard chairs/platform.
While any number of patrons are in the pool the lifeguards should be positioned in their chairs/platform not along the side of the pool.
The telephone located in the Kidder County Swimming Pool office as well as the internet/Wi-Fi is for pool business only.
Patrons must use ladders to exit the pool.
The pool may be closed, with the approval of the Kidder County Swimming Pool
Manager/Board, for any condition that creates a safety hazard.
Any physical altercation will result in immediate expulsion from the aquatics facility.
If a lifeguard doubts a patrons swimming ability, they will ask the individual to
perform a swimming test. If the individual refuses or does not pass, the swimmer must remain in the shallow water and will not be allowed in the deep end without a lifejacket.
No patrons are allowed on the deck or in the pool after closing. If patrons are found in the pool after pool hours the proper law enforcement agency will be notified as this is considered trespassing.

Kidder County Swimming Pool OPEN BODY SLIDE RULES

All riders must be 250 pounds or less
All riders must be at least 44” tall
Warning – Water depth is 3’ 6” to ride the slide you must be able to swim in this depth of water.
Single user, feet first, sitting up or laying down only! No chain of people whereby you’re holding onto one another, or holding small children while sliding. Absolutely, no head first position down the slide.
Do not propel yourself onto the slide.
No running, standing, kneeling, rotating, tumbling or stopping inside the flume. Arms and hands must always remain inside the flume.
A lifeguard is required to be present at the pool during slide operation.
Due to health risks, use of the water slide is not recommended for pregnant women.
Users must not be under the influence of alcohol or drugs.
Users are to use only after splash down area is cleared.
Absolutely, no diving from the slide.
No life jackets, loose clothing, jewelry or items in pockets are to be worn/present while sliding.
All lifeguards and other pool personnel are expected to follow these rules.
Maximum occupancy: a) 1 person per flume. Stairs and tower are designed for 100lb per square foot load.
No running on the slide, pool deck around slide, flumes, tower, or stairs.
No patrons are allowed under the slide tower, stairs, & flume – this area is
for staff members only.

I have read this waiver, along with the KCSP rules and regulations, and I fully understand its contents. I acknowledge that by signing this waiver, I am giving up substantial legal rights, including the right to sue the Organization.

Date*

Date

By typing my name below, I acknowledge and agree that my electronic signature is the legal equivalent of my handwritten signature. I consent to be legally bound by the terms and conditions outlined in this agreement for the entirety of this year. I further agree that my electronic signature has the same validity and enforceability as a signed hardcopy document.*

Phone Number*

Please enter a valid phone number.

Name of Parent/Legal Guardian

First NameLast Name

Name of Minor

First NameLast Name

Name of Minor

First NameLast Name

Name of Minor

First NameLast Name

Name of Minor

First NameLast Name

Name of Minor

First NameLast Name

In connection with and consideration of my child's (named above) swimming and
related activities, I, on behalf of my child and myself, my heir(s), personal representative(s) and assign(s), hereby represent and agree as follows:

I understand that I will be liable for any damages and their conduct. All swimmers must have a safe, responsible behavior at the KCSP. He/she will be expected to meet all the requirements and adherence to all policies and procedures.

I, the undersigned, certify that I am the parent or legal guardian of the child (named above) and that I have the right to make decisions for my child that affect his/her well-being. I recognize and acknowledge physical injury, accident, illness, death, and loss of personal property. I voluntarily assume all responsibility and risk of loss, damage, illness, and/or injury to person or property which my child may, in any way, sustain in connection with his/her participation.

I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER AND THAT I HAVE READ, FULLY
UNDERSTAND AND AGREE TO THE TERMS OF THIS AGREEMENT, AND I SIGN IT
VOLUNTARILY WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

I authorize the release to the media of any pictures of my child during his/her time as a participant.

YesNo

By typing my name below, I acknowledge and agree that my electronic signature is the legal equivalent of my handwritten signature. I consent to be legally bound by the terms and conditions outlined in this agreement. I further agree that my electronic signature has the same validity and enforceability as a signed hardcopy document.

Date Signed

Date

Name of Emergency Contact

First NameLast Name

Emergency Contact (If phone number is different then listed above)

Please enter a valid phone number.

Kidder County Swimming Pool Waiver Release Form

Parental/ Legal Guardian Consent If Under The Age of 18