SEA TEAM
I, ______________________________________, agree to and hereby release SEA; the SEA coaching staff;
(Print Name of Parent, Guardian, or Adult Swimmer)
North Carolina Swimming, Inc.; and USA Swimming, Inc.; and United States Masters Swimming, Inc.; their agents and employees from all liabilities and claims arising by reason of injuries that may occur to
_________________________________________________________
(Print Name of Swimmer)
while participating in the programs of the South Eastern Aquatics Swim Team, including travel to and from training sessions, other scheduled activities, and swimming meets. I agree to indemnify and hold harmless the above mentioned, their agents and employees, against any and all liability for personal injury, including injuries resulting in death, or damage to property, or both, while enrolled in the program. I agree to reimburse the above for any and all damages they are compelled to pay arising from any such claim, demand, action, or cause of action as may arise from my or my child�s action while enrolled in the program.
____________________________________________ __________________________________________
SIGNATURE DATE
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Emergency Medical Treatment Authorization
I, ___________________________________________________________________,
(Print Name of Parent, Guardian, or Adult Swimmer)
in the event that I cn not be reached to make arrangements for emergency medical attention, authorize the staff and / or coaches of the South Eastern Aquatics Swim Team to take my child,
_____________________________________________,
(Print Name of Swimmer)
to _________________________________________________________
(Print Name of Physician)
or to the nearest emergency medical facility. If the named physician is not available, I authorize the staff and coaches to obtain emergency medical attention and treatment for my child at a hospital or clinic of their choice. I give consent to the hospital or clinic, and physicians to render the necessary emergency treatment to my child.
____________________________________________ __________________________________________
SIGNATURE DATE
Insurance Company: ___________________________ Policy Number: ____________________________
Name of Insured: ______________________________ Group Number: ____________________________
Known Drug Allergies: ______________________________________________________________________
Known Medical Conditions: __________________________________________________________________
Emergency Telephone Numbers: Work (_____)_______________ Home (_____)_________________
Family (_____)______________ Friend (_____)_________________
This information is important to ensure treatment and reimbursement for medical expenses incurred when parents are not available!
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Photo Release
Photo Release Permission form for Minors:
I, being Parent/Guardian of _______________________________________ , hereby consent that photographs and/or videotape in which my child appears during membership with South Eastern Aquatics Swim Team, may be used by South Eastern Aquatics Swim Team, its assigns or successors, in whatever way they desire, including television, world wide web, and electronic media; furthermore, I hereby consent that such photographs, and recordings, from which they are made shall be their property, and they shall have the right to duplicate, reproduce and make other uses of such photographs, and tapes as they may desire free and clear of any claim whatsoever on my part. I agree to indemnify and hold harmless from any claims the following:
South Eastern Aquatics Swim Team members, employees, board members, and volunteers
Parent/Guardian Signature: ____________________________________ Date: _______________________
Address: ___________________________________________________ Phone: ______________________
Photo Release Permission form for Adults:
I, _______________________________________ , being of legal age, hereby consent that photographs and/or videotape in which I appear during membership with South Eastern Aquatics Swim Team, may be used by South Eastern Aquatics Swim Team, its assigns or successors, in whatever way they desire, including television, world wide web, and electronic media; furthermore, I hereby consent that such photographs, and recordings, from which they are made shall be their property, and they shall have the right to duplicate, reproduce and make other uses of such photographs, and tapes as they may desire free and clear of any claim whatsoever on my part. I agree to indemnify and hold harmless from any claims the following:
South Eastern Aquatics Swim Team members, employees, board members, and volunteers
Signature: _________________________________________________ Date: _______________________
Address: ___________________________________________________ Phone: _____________________