Swimmer's Name

First Name

Last Name

The same email address that you did let us know

Phone

(###)

###

####

Practice Group

A Group

C Group

E+ Group

E Group

Your previous swim class info (Day & Time)

EX) Saturday 5:15pm

Memo

Anything you would like to let us know or questions you may have?

Waiver of Liability and Indemnification Agreement

We, the parent(s)/legal guardian(s), of the Registrants(s) named hereinafter give my/our approval to our/their participation in any and all activities. The undersigned attest to having personal knowledge and represent that the Registrant(s) is/are in good physical and emotional condition and health such that there are no restrictions on the Registrant(s) to participate in any of the activities of the New Jersey Swimming Group Inc. I/We hereby waive, release and discharge any and all claims and damages for personal injury, death, or property damage which We/Guest or my minor children may sustain or which may occur as a result of me/my/guest or my minor children’s participation in any activities. I understand and agree that This release is intended to discharge in advance New Jersey Swimming Group Inc., its officers, employees from and against any and all liability, except for their sole negligence or intentional acts, connected in any way with the participation of myself/guest or my minor child(ren) in activities. The described activity may be of a hazardous, strenuous, and/or physical nature. Participation in the described activity may occasionally result in injury, death or property damage; knowing the risk involved, nevertheless I voluntarily request permission for myself/guest or minor child (ren) to participate in the described activity. I herby assume any and all risks of injury, death or property damage and agree to release and hold harmless New Jersey Swimming Group Inc., its officers, employees, except for their sole negligence or intentional acts: This waiver, release and assumption of risk is binding on my heirs and assigns; I will indemnify and hold New Jersey Swimming Group Inc. harmless from any loss, liability, damage, cost or expense, including litigation, which it may incur as a result of any injury and/or property damage which I/We/guest or minor child(ren) may sustain while participating in said activities. I will make good any loss, damage, or cost New Jersey Swimming Group Inc., may have to pay if any litigations arises on account of any claim made by said minors/guest or by anyone on said minor’s behalf. In the event that said myself/guest or minor child (ren) requires medical or surgical treatment while under the supervision of NJSG Personnel in connection with the described activity, NJSG Personnel may authorize treatment. I/We will pay all medical, hospital, or other expenses which I/We/guest or minor child (ren) may incur as a result of such treatment. Activities are not child care as defined by the State of New Jersey.

COVID-19 Liability Waiver

Name of business: NJ Swimming Group I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Business has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that New Jersey Swimming Group cannot guarantee that I will not become infected with the Coronavirus/Covid- 19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, New Jersey Swimming Group's staff and members and their family. I voluntarily participate in swim services provided by New Jersey Swimming Group and acknowledge that I am increasing my risk of exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while swim services. I represent and confirm that the items below are true: (1) I am not currently experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. (2) I have not traveled internationally within the last 10 days. (3) I have not traveled to a highly impacted area within the United States of America in the last 10 days. (4) To my best knowledge, I have not been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. (5) I have not been diagnosed with Coronavirus/Covid-19. (6) I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. I hereby release and agree to hold New Jersey Swimming Group harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of New Jersey Swimming Group, or that may otherwise arise in any way in connection with any services received from New Jersey Swimming Group. I understand and agree that this release discharges New Jersey Swimming Group from any liability or claim that I, my heirs, or any personal representatives may have against New Jersey Swimming Group with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from New Jersey Swimming Group. I also agree that this liability waiver and release extends to New Jersey Swimming Group together with all staff and NJSG members.

We have received your request and it's under review to finalize.

Once it's ready, usually within 3 days, a confirmation email will be sent from our reservation system (AcuityScheduling).

If you have any further questions please email us; NJSG@NewJerseySwimming.com

ACE

Swim Meet Commitments

www.NewJerseySwimming.com