Coral Springs Aquatic Complex Waiver

CORAL SPRINGS
EVERYTHING UNDER THE SUN
MINOR CHILD / HOUSEHOLD INFORMATION
Name of Participant:

First NameLast Name
Address of Participant:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth:

MonthDayYear
Date
Main Phone:
Format: (000) 000-0000.
Alternate Phone:
Format: (000) 000-0000.
Parent/Legal guardian:
Relationship to child:
Email Address:
example@example.com
Emergency Contact:
Phone Number:
Format: (000) 000-0000.
Cell Number:
Format: (000) 000-0000.
Insurance Company:
Policy Number:
AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT
I.
(Parent/Guardian), hereby grant permission for my son/daughter/ward
(Participant Name) to participate in the above activities and any or all field trips during activity. I also authorize the City of Coral Springs to obtain, through a physician of its own choice, any emergency medical care that may become necessary for my child as a result of an accident or sudden illness.
List of allergies, medications, Special Notes:
Parent/Guardian/Ward Signature:
ACKNOWLEDGMENT OF NO REFUNDS/MAKE-UP POLICY
I understand the City of Coral Springs has a No Refund policy for fees and charges paid to this Department for activities sponsored by them. The only exceptions to this policy will be when an activity is canceled, or the City alters its time. No other circumstances or situations will qualify for a refund.
By:
Date:

MonthDayYear
Date
I asked the signor if he/she is aware of what is being signed.
Witness:
Date:

MonthDayYear
Date
CITY OF CORAL SPRINGS, FLORIDA PARKS AND RECREATION DEPARTMENT
2501 Coral Springs Drive Coral Springs, Florida 33065
Phone: 954-345-2200 Fax: 954 345 2111 CoralSprings.org

"RECREATIONAL PROGRAM"
RELEASE AND WAIVER FOR MINOR CHILD
NOTICE TO THE MINOR CHILD'S NATURAL GUARDIAN
PURSUANT TO SECTION 744.301, FLORIDA STATUTES
READ THIS FORM COMPLETELY AND CAREFULLY. YOU
ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN
A POTENTIALLY DANGEROUS ACTIVITY.
YOU ARE AGREEING THAT, EVEN IF THE CITY OF CORAL
SPRINGS USES REASONABLE CARE IN PROVIDING THIS
ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE
SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN
THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS
INHERENT IN THE ACTIVITY WHICH CANNOT BE
AVOIDED OR ELIMINATED.
BY SIGNING THIS FORM YOU ARE GIVING UP YOUR
CHILD'S RIGHT AND YOUR RIGHT TO RECOVER FROM
THE CITY OF CORAL SPRINGS IN A LAWSUIT FOR ANY
PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD
OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE
RISKS THAT ARE A NATURAL PART OF THE ACTIVITY.
YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM,
AND THE CITY OF CORAL SPRINGS HAS THE RIGHT TO
REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO
NOT SIGN THIS FORM.
[BALANCE OF PAGE INTENTIONALLY LEFT BLANK]
Doc. 135790
Page 1 of 2

In consideration of the City of Coral Springs granting my child permission to participate in the Recreational Program, and all related activities associated with this program, ("Program"), I, ____________________ (parent/guardian) give permission for my minor child, ____________________, to participate in the Program and hereby agree to sign this Release and Waiver.
Accordingly, I, both individually and in the representative capacity of my child, agree to unconditionally release, waive, and discharge the City of Coral Springs, its Commission members, employees, agents, and servants, all hereafter referred to as "releasees," from all claims and courses of action, that I, my personal representatives, assigns, heirs, and next of kin, may have for any loss, damage, or injury to person or property, whether caused by the negligence, or otherwise of the releasees. In addition, I agree to release against all claims, demands, and actions arising out of either my own and/or my minor child's actions or involvement with the City of Coral Springs in relation to the Program.
I certify and warrant that my minor child is in good health and physical condition and is able to participate in the Program and all related events.
Additionally, I agree that my minor child will adhere to all applicable rules and regulations of the City of Coral Springs.
I have carefully read the foregoing release and waiver, including the statutory notice on the first page, and know the contents thereof. I fully understand the risks that my child may encounter with his/her involvement and activity with the Program. I understand the contents of this Release and Waiver, and I am signing this Release and Waiver as my own free act.
I expressly agree that this Release and Waiver is intended to be as broad and as inclusive as permitted by the laws of the State of Florida, and that if any portion thereof is held invalid, it is agreed that the balance shall notwithstanding, continue in full force and effect.
In Witness Whereof, I have executed this Release and Waiver on ______________, 20____.
By:
By:
WITNESS:
Emergency Contact Phone Number
Format: (000) 000-0000.
Doc. 135790
Page 2 of 2
Should be Empty:

CORAL SPRINGS

MINOR CHILD / HOUSEHOLD INFORMATION

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

ACKNOWLEDGMENT OF NO REFUNDS/MAKE-UP POLICY