Swim Instructor Permission Form


Har-Ber Address

CHILDREN TO BE SUPERVISED BY POOL INSTRUCTOR

I GIVE PERMISSION FOR TO CARE FOR MY CHILD/CHILDREN AT THE HAR-BER MEADOWS COMMUNITY POOL WITHOUT MY SUPERVISION. I UNDERSTAND AND AGREE THAT MY PERMISSION GRANTED HEREBY IS AT MY SOLE RISK. I UNDERSTAND AND AGREE THAT THE HAR-BER MEADOWS COMMUNITY POOL, IT’S EMPLOYEES & BOARD MEMBERS SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR EXEMPLARY DAMAGES RESULTING FROM THE USE OF THE HAR-BER MEADOWS COMMUNITY POOL BY MY INSTRUCTOR OR MY CHILDREN WHEN UNACCOMPANIED TO THE POOL BY ME NOR SHALL HAR-BER MEADOWS COMMUNITY POOL BE RESPONSIBLE FOR MORE THAN ITS NORMAL STATED RESPONSIBILITIES UNDER ITS RULES AND REGULATIONS AND BY-LAWS. IN ADDITION, MY INSTRUCTOR WILL ABIDE BY THE POOL RULES, ANY ABUSE RESULTING IN THEIR LOSS OF POOL PRIVELEGES. IF DEEMED NECESSARY BY POOL ATTENDANTS AND/OR POOL MANAGERS, IN CASE OF A MEDICAL EMERGENCY, YOUR SIGNATURE AUTHORIZES CONSENT FOR MEDICAL TREATMENT AND YOU WILL BE LIABLE FOR MEDICAL COSTS INCURRED.

Leave this empty:

Signed by John Duke
Signed On: June 11, 2017

Har-Ber Meadows https://harbermeadows.org
Signature Certificate
Document name: Swim Instructor Permission Form
Unique Document ID: 441732d7c4a69328882ffb52c6fdf8f1ebd149a1
Timestamp Audit
2017-05-21 10:22:37 CDTSwim Instructor Permission Form Uploaded by John Duke - manager@harbermeadows.org IP 72.204.70.48
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