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Please fill out one form per athlete

Athlete Information

Parental Information

Emergency Contact

Parental Authorization

I hereby give permission for the child listed to participate in the activity listed on the registration form. I hereby acknowledge that there are obvious risks of injury involved in participation in all sports activities specifically, the sports activities for which I have registered my child as set forth above. I hereby give permission for official records to be checked for age/residency verification of the child listed. I, the parent/guardian of said child, assume all risks and hazards incidental to such participation, including transportation to and from activities. I do hereby waive, release absolute and indemnify and agree to hold harmless the swim club, YMCA,  MCCPRA, Colquitt County Commissioners, partners, sponsors, supervisors, participants and persons transporting the child to and from activities for any claim arising out of injury to the child. I do hereby covenant that on behalf and for the minor not o file a claim or bring suit with respect to any such injury or damage. I give permission to a representative of the swim club and/or sponsoring agency/agent, licensed physician and emergency medical personnel to obtain medical treatment for the minor of which I am either parent or guardian should the child become injured or ill in the event I am not available and medical treatment is required. The physicians, medical personnel, agents, the swim club, or any employees of the swim club, City of Moultrie, and Colquitt County are hereby released for ny claim with respect to such injury during the event of program, including transportation to or from the event and/or to any program. I understand that if hospitalization or medical treatment or a more serious nature is required I will be contacted, if all possible, by telephone for permission. I hereby authorize the swim club and its representatives the irrevocable right to use my child's name, picture, photograph or likeness without any compensation and in perpetuity in all forms of media and in all matters. I hereby released hold harmless the swim club from any reasonable expectation of privacy or confidentiality for myself and for the minor child/children listed above and that I have full authority to consent and authorize the swim club to use their likeness and names. I further acknowledge that participation is voluntary and that neither I, the minor child/children will receive any financial compensation or any type associated with the taking or publication of these photographs for participation in marketing materials or other publications. I acknowledge and I agree that publications of said photos confers no rights or royalties what so ever. I hereby further release the swim club, its employees and any third parties involved in the creation of the publication form liability for any clams by me or any third party in connection with my participation or my child/children participation as listed above.

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