Clubhouse Kids Polar Bear Swim

Clubhouse Kids Polar Bear Swim

February 8 from 12:30 to 4 PM, FREE TO YOU, Please bring a towel, swimsuit and a change of clothes. Bring car seats if needed.
Student Name*

First NameLast Name
Grade*
Parent Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
Emergency Contact If Different from above*

First NameLast Name
Emergency Phone if different from above*

Area CodePhone Number
I hereby grant permission for my child to attend the Polar Bear Swim, at the YMCA in High Point. In my capacity as self, spouse, parent or legal guardian, I am aware that there are certain normal and reasonable risks associated with participation in swimming activities. I hereby waive any right that I, my spouse, or said minor child may have to sue Shady Grove Church and/or the YMCA or any of their employees, as a result of any and all injuries, damages, and/or losses sustained at the YMCA pool. I further agree to hold Shady Grove Global Methodist Church and/or the YMCA and any of their employees blameless and I agree to bear the cost of their legal defense if any suit of legal or equitable action is brought against any of them as a result of any and all injuries, damages, or losses suffered by me, my spouse, or my child while at the YMCA pool. Finally, I hereby appoint Leigh Tuttle, Children’s Pastor, or emergency personnel on duty to act in place of myself or my spouse to hospitalize and/or secure proper treatment and/or order injection or anesthesia or surgery for my child if I, my spouse, or my child is unable to act on our own behalf or if I or my spouse are unable to be notified of above medical treatment beforehand.
Parent Signature
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