SWIMMER 1 *

First Name

Last Name

DATE OF BIRTH

MM

DD

YYYY

SWIMMER 2

First Name

Last Name

DATE OF BIRTH

MM

DD

YYYY

SWIMMER 3

First Name

Last Name

DATE OF BIRTH

MM

DD

YYYY

SWIMMER 4

First Name

Last Name

DATE OF BIRTH

MM

DD

YYYY

SWIMMER 5

First Name

Last Name

DATE OF BIRTH

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parents Name

First Name

Last Name

Phone

(###)

###

####

Are you a Bath and Tennis Member *

YES

NO

COVID-19 WAIVER OF LIABILITY AND INDEMNIFICATION *

1. I agree that I am personally responsible for my safety and actions while using the Columbia Bath and Tennis Club (CBTC). I agree to comply with all CBTC policies and rules, including but not limited to all the CBTC policies, guidelines, signage, and instructions. Because CBTC is open for use by other individuals, I recognize that I am at a higher risk of contracting COVID-19. With full awareness and appreciation of the risks involved, I, for myself and on behalf of my family, spouse, estate, heirs, executors, administrators, assigns, and personal representatives, hereby forever release, waive, discharge, and covenant not to sue CBTC, its board members, or employees (collectively the "Released Parties"). I waive the released parties from any and all liability, claims, demands, or injury, including death, that may be sustained by me related to COVID-19 whether caused by the negligence of the released parties, any third party using CBTC, or otherwise, while participating in any activity while in, on, or around CBTC, or while using any CBTC facilities, equipment, or materials. 2. I agree to indemnify, defend, and hold harmless the released parties from any and all costs, expenses, claims, lawsuits, judgements, losses, and/or liabilities (including attorney fees) arising either directly or indirectly from or related to any claims made by or against any of the released parties or otherwise specifically related to COVID-19. 3. By signing the following I acknowledge and represent that I have read the foregoing waiver of liability, understand it, and sign it voluntarily as my own free act and deed, including without limitation the release of liability and indemnification requirements contained in this document; I am sufficiently informed about the risks involved in using CBTC to decided whether to sign this document; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this document for full, adequate, and complete consideration fully intending to be bound by the same. I agree that this waiver of liability shall be governed by and construed in accordance with Illinois law, and that if any of the provisions hereof are found to be unenforceable, the remainder shall be enforced as fully as possible and the unenforceable provision(s) shall be deemed modified to the limited extent required to permit enforcement of the waiver of liability as a whole. This waiver remains in effect until the State of Illinois lifts all COVID-19 related mandates. I have read and agree to the terms above.

YES

NO

CB&T HURRICANES LIABILITY RELEASE *

I, the undersigned participant and parent, request voluntary participation for minor to participate in all events, which are hereinafter referred to as the “activities.” sponsored by Columbia Bath and Tennis Club, the Columbia Hurricanes and the Kaskaskia Swim League. This agreement is valid while the participant is a member of the Columbia Hurricanes. I consent to my/minor’s participation in the activities and acknowledge that the minor and I fully understand my/minor’s participation may involve risk of serious injury or death, including losses which may result not only from my/minor’s own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the event or activity is being conducted, and/or the rules of play of this type of event or activity. I understand that if I have any risk concerns, I should discuss the risks associated with my participation with the activity coordinators and event staff, before I sign this document and before any activities begins. Release – Minor’s Rights: In consideration of allowing Minor Participant to participate in the activities, I hereby release and hold harmless Columbia Bath and Tennis Club, the Columbia Hurricanes and its local swimming committee and their members of its board of directors, officers, employees, volunteers, other participants, and agents (collectively, the “Released Parties”), of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that Minor Participant may have or sustain with respect to any and all damage and/or injury, of any type, arising out of his or her participating in the activities. I also agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect. Do you agree to the conditions of the release as stated above?

YES

NO

CB&T HURRICANES INDEMNIFICATION FORM *

Indemnification by Parent/Guardian: The undersigned parent/guardian further agrees to indemnify, save and hold harmless the Released Parties from any and all claims, demands, losses, damages and liabilities for indemnities, contribution or otherwise with respect to any damage and/or injury, of any type, arising from Minor Participant’s participation in the activities. The undersigned also agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by the Releasee and is intended to be as broad and inclusive as is permitted by the laws of the State in which the Event(s) is/are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Do you agree to the terms of the form as written above?

YES

NO

PHOTOGRAPHY RELEASE *

I grant the Columbia Hurricanes permission to take and use my child’s photograph for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising and web content. Futhermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use. Do you agree to the terms of the form as written above?

YES

NO