Requested Date and Time * Name of Swimmer *
* Phone * Email *
DOB * Names of Parents / Legal Guardians What are your expectations from the calls? * How many hours per week do you train? * Are you training for a particular competition or purpose? * What are your personal best times in your best events? * Is there anything else we should know about you, excluding medical information? Do you have any special requests? * Gary Hall Sr. Devin Murphy Consent, Release and Authorization to Reproduce Physical Likeness and Name *
I hereby agree and consent to your photographing, filming, taping and/or recording my likeness, voice, sound and quotes, knowing that you will incur substantial expense in reliance upon this Consent, Release, and Authorization (this “Consent”), and for other good and valuable consideration, the adequacy and receipt of which is hereby acknowledged, I hereby grant to you and your parent, related and affiliated companies, and their respective licensees and assigns, and the directors, officers, employees and agents of each, forever and throughout the world, the right to use and license and the right to reuse such photographs, films, tapes and/or recordings of my likeness, voice sound, quote and my name, in all media, whether now known or hereafter devised, throughout the universe in perpetuity (including, without limitation, in films, newspapers, magazines, on radio, television, commercials, merchandise, video cassette, video disk, exploitations, digitized images, whether for advertising, publicity, or promotional purposes and for any other purpose what so ever, without further compensation to me or any limitation whatsoever. In granting this license, I understand that The Race Club is not under any obligation to exercise any of its rights, licenses and privileges herein granted.I hereby release The Race Club from all claims, demands, liabilities, damages, costs and expenses (including, but not limited to, attorney’s fees and fees of other professionals) that I may now or hereafter have against The Race Club arising in connection with the use of my likeness, voice sound, and quote in such photographs, films, tapes and/or recordings and your exercise of the rights hereby granted.This consent shall be binding upon my heirs, personal representatives and me and assigns and shall be governed by and construed under the laws of the State of Florida. I certify that I am 18 years of age or older.
Release and Waiver of Liability *
I hereby hold The Race Club and its staff free from all liability should any injury or illness befall me while I am in attendance at The Race Club Camp. I also authorize The Race Club Staff to secure medical treatment for me should I not be able to request such treatment for myself. I have no knowledge of any existing physical impairment that would affect my participation in this program. In addition, I authorize The Race Club to use any photographs of me taken during the program for use in publicizing and advertising future Race Club Swim Camps. In consideration of being allowed to participate in any way with (Name of Organization), its related events and activities, I, by agreeing to this online form, acknowledge, appreciate, and agree that: The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS (Name of Organization) their officers, officials, agents and/or employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Refund Policy and Special Notes *
The Race Club reserves the right to cancel all, or any portion of, the camp/privates due to weather, acts of God, or any other reasons within or beyond it’s control. A $250 deposit fee is taken at the time of registration and is non-refundable unless The Race Club cancels a camp/privates due to unforeseen circumstances. Any cancellation made under 30 days but over 14 days prior to the start of the camp/privates will be charged 50% of the total cost of the camp/privates. Any cancellation made less than 14 days prior to the start of the camp/privates, the total cost of the camp will be charged. In order to protect their camp/privates investment against loss of camp/privates tuition due to injury, illness, or other covered circumstance, campers are encouraged to purchase travel insurance. The camp/privates does not provide coverage. Go to www.insuremytrip.com to create your own personal insurance policy and get insurance quotes from different insurers.