LORI'S H2O SKILLS SWIM REGISTRATION FORM
Date: ________
__
Participant's Name(s)
Name and Fee:
_____________
_____________
_____________
_____________
Total: ________
____________
Age(s)
____________________________________________
Parent's Name if Participant Under 18
Phone
_____________________________
Participant's Home Address
Please Circle Level:
RUBBER DUCKIES
_________________
Email Address
RAINBOW WHITE
Class Time(s): _________
RED
BLUE
Office Use ONLY
(Please circle)
Class Type: Group/Private
Day(s) of the Week (Please circle): M, T, W, Th, F, Sa
Class(s) Begins On: ___________
End(s) On: ____________
Teacher Name(s): Lori Weber/Kim Kendall/Tracy Dargis
Your Tuition Fee Is: $_____________
NO REFUNDS AVAILABLE
$70 Group (3 to 1)
$60 Group (5 to 1)
$60/$120 (Get Start)
$80/$160 PL (4 pack)
$105/$210 PL (6 pack)
Lori's H2O Skills, LLC. Participant Agreement
Waiver of Liability, Indemnity Agreement, Assumption of Risk
Waiver of Liability
In consideration of permission to use (today and on all future dates) the property, facilities, and services of Lori's H2O Skills, LLC, the undersigned Participant and Parent or Guardian, on behalf of
participant, participant's heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue Lori's H2O Skills, LLC, its directors, officers, employees, volunteers,
independent contractors, agents, and insurance carriers from liability for any and all claims including those arising from negligence of Lori's H2O Skills, LLC. or any of its aforementioned parties.
This agreement applies to 1) personal injury (including death) from accidents or illnesses arising from participation in Lori's H2O Skills activities including, but not limited to organized activities, classes
observation, and individual use of facilities, premises, or equipment: and 2) any and all claims resulting from damage to, loss of, theft of property.
Indemnification and Hold Harmless: The undersigned Parent or Guardian further agrees to HOLD HARMLESS, DEFEND, AND INDEMNIFY LORI'S H2O SKILLS, LLC, from all claims arising
directly or indirectly from participation of the participant at Lori's H2O Skills, LLC, including those resulting from negligence of Lori's H2O Skills, LLC. The undersigned Parent or Guardian further
agrees to pay all costs and attorneys' fees incurred by Lori's H2O Skills, LLC, in investigating and defending a claim or suit arising from the participation of the Participant.
The undersigned further expressly agrees that this agreement is intended to be as broad and inclusive as is permitted by law of the State of Ohio and that any portion thereof is held invalid, it is agreed
that the balance shall, notwithstanding, continue in full legal force and effect. Likewise, the undersigned agree that if legal action is brought, it must be brought in District Court residing where the
incident occurred or in the appropriate Federal Court in the State of Ohio.
Swimming activities, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another
and include slips, falls, colliding with the wall, and being struck by another swimmer. These risks can result in injury ranging from 1) minor injuries such as scratches, bruises, and sprains to 2) major
injuries such as loss of vision, joint injuries, concussions and heart attacks to 3) the very rare catastrophic injuries including paralysis and death. The undersigned Participant and Parent or Guardian
hereby asserts that participation is voluntary and that the undersigned Participant and Parent or Guardian knowingly assumes all such risks.
Acknowledge of Understanding: The undersigned Participant and Parent or Guardian have read this participant agreement and fully understand that we are relieving Lori's H2O Skills, LLC, from
liability from injuries resulting from negligence of Lori's H2O Skills, LLC, and from the inherent risks of the activity. The undersigned understands that the Participant is relinquishing substantial
rights, including the right to sue. The undersigned acknowledge that their signatures below are given freely and voluntarily, and intend the signatures to be a completer and unconditional release of
all liability to the greatest extent allowed by law in the State of Ohio.
__________________________
____________________________
_______
Printed Name of Participant
Signature of Participant
Date
__________________________
____________________________
_______
Printed Name of Parent or Guardian
Signature of Parent or Guardian
Date