This
signed form is required for each swimmer. Bring the signed forms with you
to registration. YMCA Association #: ____________________________ YMCA_NAME: ______________________________________________________ YMCA_ADDRESS:____________________________________________________ |
Check the applicable box:
_______ I, the parent/legal guardian of
___________________________________________________, do hereby give my approval of his/her participation in
the 2020 YMCA SHORT COURSE CHAMPIONSHIP
to be held at the GREENSBORO,
NC, and agree to the terms below.
______ I, ____________________________________, state that I am at least 18 years of age and I wish to participate in the
2020 YMCA SHORT COURSE CHAMPIONSHIP to be
held at the GREENSBORO, NC, 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,
GREENSBORO AQUATIC CENTER, 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,
GREENSBORO AQUATIC CENTER,
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 :https://www.teamunify.com/yusa/__doc__/SportsNationalChampionshipConcussionMemo.pdf
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
GREENSBORO AQUATIC CENTER 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
_____________________________________________________
Printed Name
REQUIRED TO PARTICIPATE IN THE MEET