Sigma Gamma Rho Sorority, Inc Epsilon Kappa Sigma Dayton Alumnae Chapter: 2026 Swim1922 - Swimmer Registration

Media Release Form

1) I, the undersigned, hereby authorize USA Swimming, Inc and EKS. (USA Swimming and Epislon Kappa Sigma), its agents and employees the irrevocable and unrestricted right to photograph me, take motion pictures of me, take video footage of me, and/or make electronic sound recordings of me (herein referred to as photographic or electronic reproductions). 

2) I authorize the use of any such photographic or electronic reproductions of me for any purpose, including, but not limited to publication, promotion, illustration, advertising, or trade, in any manner or in any medium deemed appropriate by USA Swimming and EKS for educational and other public media (I understand that I may be identifiable from such photographic or electronic reproduction). 

3) I hereby consent and agree that such photographic or electronic reproductions shall be the sole property of USA Swimming and EKS and that USA Swimming and EKS has the right to duplicate and reproduce the images as it may desire, free and clear of any claim on my part. 

4) I hereby release USA Swimming and EKS and its legal representatives for all claims and liability relating to said photographic or electronic reproductions. Furthermore, I grant permission to use my statements that were given during an interview with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation. This authorization shall remain in effect until revoked by me in writing. 

Parental Consent

It is USA Swimming’s and EKS’s policy not to identify minors by full name or address in any photographs, videos or publications used. By agreeing below, I (i) certify that I am the legal parent/guardian of the individual above, a minor under the age of eighteen years (Minor Athlete); (ii) grant USA Swimming and EKS permission to use Minor Athlete’s image in photographic or electronic reproductions; (iii) consent that such photographic or electronic reproductions may be used by USA Swimming and EKS in whatever way it desires for future promotional appearances; and (iv) hereby agree to assume legal responsibility for authorizations made in this Media Release.

LIABILITY RELEASE AND INDEMNIFICATION FORM OF NON-MEMBER

I, the undersigned participant and parent, request voluntary participation for minor to participate in the Swim1922 activity on May 16, 2026, which begins at 10:00 AM EST and ends at 2:00 PM EST sponsored by Epsilon Kappa Sigma Dayton Alumnae Chapter of Sigma Gamma Rho Sorority, Inc. all of which are hereinafter
referred to as the “activity.”

I consent to my/minor’s participation in the activity and acknowledge that the minor and I fully understand my/minor’s participation may involve risk of serious injury or death, including losses which may result not only from my/minor’s own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the event or activity is being conducted, and/or the rules of play of this type of event or activity. I understand that if I have any risk concerns, I should discuss the risks associated with my participation with the activity coordinators and event staff before I sign this document and before the activity begins.

Release – Minor’s Rights:
In consideration of allowing Minor Participant to participate in this event, I hereby release and hold harmless Epsilon Kappa Sigma Dayton Alumnae Chapter of Sigma Gamma Rho Sorority, Inc. Club, USA Swimming, its local swimming committees and their members of its board of directors, officers, employees, volunteers, other participants, and agents (collectively, the “Released Parties”), of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that Minor Participant may have or sustain with respect to any and all damage and/or injury, of any type, arising out of his or her participating in this USA Swimming and EKS event. I also agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

Release – Parents’/Guardians’ Rights:
In consideration of allowing Minor Participant to participate in this event, I hereby release and hold harmless the Released Parties, of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that I may have or sustain with respect to any and all damage and/or injury, of any type, arising from Minor Participant’s participation in this USA Swimming and EKS event. I also agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

I certify that my/minor is in good health and have no physical condition that would prevent participation in this activity. Furthermore, I agree to use my/minor’s personal medical insurance as a primary medical coverage payment if accident or injury occurs. I consent to emergency medical treatment in the event such care is required.

Indemnification by Parent/Guardian:
The undersigned parent/guardian further agrees to indemnify, save and hold harmless the Released Parties from any and all claims, demands, losses, damages and liabilities for indemnities, contribution or otherwise with respect to any damage and/or injury, of any type, arising from Minor Participant’s participation in this event. The undersigned also agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by the Releasee and is intended to be as broad and inclusive as is permitted by the laws of the State in which the Event(s) is/are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.