signed form is required for each swimmer. Bring the signed forms with you
YMCA Association #: ____________________________
Check the applicable box:
_______ I, the parent/legal guardian of ___________________________________________________, do hereby give my approval of his/her participation in the 2019 YMCA LONG COURSE CHAMPIONSHIP to be held at the Eppley Recreation Center, University of Maryland, College Park, MD, and agree to the terms below.
______ I, ____________________________________, state that I am at least 18 years of age and I wish to participate in the 2019 YMCA LONG COURSE CHAMPIONSHIP to be held at the Eppley Recreation Center, University of Maryland, College Park, MD, and agree to the terms below.
I assume all risks and hazards incidental to this event. I do further release, absolve, indemnify and hold harmless the YMCA of USA, Eppley Recreation Center, University of Maryland, College Park, MD, the organizers, sponsors, supervisors, volunteers and officials, their agents, representatives or assigns. I understand that this event may be webcast and I grant to YMCA of the USA or its assignees the unlimited, irrevocable and worldwide right to distribute, publish, broadcast, digitize,reproduce and otherwise use, in whole or in part, my name, image, picture, likeness, voice, interviews, and biographical information, in any and all languages, in any and all media or formats and for advertising and promotion anywhere and at any time. I hereby waive all claims against the YMCA of USA, Eppley Recreation Center, University of Maryland, College Park, MD, the organizers, the sponsors, supervisors, volunteers, officials, their agents, representatives or assigns, for any injury to myself if I am at least age 18, / to my child (as applicable) any loss due to theft of or damage to my personal property or for any other consequential or incidental damages caused in any manner whatsoever where any such liability is attributable to the absence of ordinary or even slight care by the event organizers and the conduct of this event.
I further state there is no medical condition which I have/my child ___________________________________ has that would prevent me/him/her from participating in this event.
I have read and acknowledge the YMCA Parent/Athlete Concussion Awareness Information sheet (located at: http://ymca.ymcaswimminganddiving.org/VisitLink.asp?EntryID=2110) and understand that the YMCA of USA will remove a swimmer if the swimmer shows signs and/or symptoms of a concussion. YMCA of the USA and Eppley Recreation Center, University of Maryland, College Park, MD are not responsible for any intended or unintended consequences related to removing an athlete from competition for a head injury. This includes, but is not limited to, any financial reimbursement associated with such removal
Signature of parent or guardian or Participant if age 18 or over Date
REQUIRED TO PARTICIPATE IN THE MEET