Nashua Swim & Tennis Club

Program Waiver and Release 2008

(Please complete each item and sign below)

It is hereby understood and agreed that any accident or sickness claim will be covered by the parent's or guardian's insurance.

Company:Policy #:Signature

I hereby give my permission to Nashua Swim and Tennis Club:

Trip Release - transport my child to Program activities. Signature

Photo Release - use photos of my child in promotions and literature. Signature

Medical Release - attain emergency medical treatment for my child in the event I cannot be reached.

Signature

Nashua Swim and Tennis Club reserves the right to dismiss any child whose conduct is detrimental to the overall good of the program. In cases of gross misconduct, illness or accident, no refund will be made. No deduction is allowed for late arrival or early departure. NSTC does not assume liability for accidents, illness, or disease.

1. I understand that some activities which my child may be involved with, while in the program, may be physical in nature; thereby understanding that injuries could occur, I will not hold Nashua Swim and Tennis Club or its staff liable. I also hold harmless and indemnify Nashua Swim and Tennis Club and its staff for any accidents or injuries incurred by my child while on the Club premises.

2. The child and parents agree to abide by the rules and regulations set by the management for the health, safety and welfare of the children.

3. The program is not responsible for the child's equipment or personal belongings while in transit or at the program, if lost or damaged for any reason. The program will make every effort to provide proper supervision so that losses will be kept to a minimum. Please do not bring personal items from home.

4. Children must be picked up on time. NSTC will not be responsible for children who have not been picked up by end of published program hours. Parents who are going to be late must make separate arrangements with one of the counselors.

I have read and signed, and I am fully aware of each of the agreements outlined above.

Today's Date:Signature of Parent or Guardian:Emergency Tel.

Health Form 2008

I have examined onand found him/her to be in good health and able to participate in a strenuous sport program.

Conditions such as allergies or physical limitations that Nashua Swim and Tennis Club should be aware of:

Medications taken regularly

Physicians name (please print): Date:

Physician's signature: Office Phone:

 

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