Tri County Swimming Pool Association

Permission to Participate and Liability Release

I, _______________________, the participant (or the parent(s)/guardian(s) of the participant agree to participate (or allow my child(ren) and family members to participate) in the TRI-COUNTY SWIMMING POOL ASSOCIATION (TCSPA) swim program as a member of the Erlton Swim Team and hereby release TCSPA, its officers and / or staff members, and Erlton Swim Club, its staff, agents, and /or employees from liability from and injury that may occur to myself (or my child(ren) and family member(s) while participating in the TCSPA swim program, including travel to and from, training sessions or other scheduled activities. I agree to indemnify and hold harmless the above mentioned organizations and/or individuals, their agents and/or other family members or damage to my property, the property of my children and/or other family members, or both, while I (or my child(ren) and /or family members) are participating in the program. I agree to reimburse the above parties for any damages they are compelled to pay arising from any such claims, demand, action or cause of action by myself (or my child(ren) and family members).

I have noted on the back of this form any medical history or problems of which the staff should be aware that would or could affect training and/or competition.

NAME_________________________________

(Please Print)

SIGNED _______________________________Date__________________________

(Participant if over age 18 or Parent/Guardian)