Participant Waiver Form
Event Name:
Date of Event:
Location:
Champagne Swim Centre
1. General Release and Waiver
In consideration of being permitted to participate in the pool party at Champagne Swim Centre, I, the undersigned parent/guardian, hereby release, waive, and discharge the facility, its owners, employees, and the party hosts from any and all liability, claims, or demands arising out of any loss, damage, or injury, including death, that may be sustained by the participant while in or around the pool premises.
2. Supervision and Safety Rules
I understand that swimming involves inherent risks. I agree to ensure the participant adheres to all pool rules, including:
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No running on the pool deck.
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No diving in shallow areas.
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Listening to the instructions of lifeguards or staff at all times.
3. Age-Specific Requirements
For Children Under 10 Years Old:
Active Supervision: A parent or responsible adult (16+) must be in the water within arm’s reach of any child who is a non-swimmer or under the age of 6.
Life Jackets: Children under 10 who cannot pass a standard swim test may be required to wear a Coast Guard-approved life jacket (bring their own).
Ratios: I acknowledge that one adult may supervise no more than 2 children under the age of 10 at one time.
For Children 10 Years and Older:
Swim Competency: Children 10 and older may swim without an adult in the water, provided they have demonstrated basic swimming competency or passed a facility swim test.
Deck Supervision: An adult must remain on the pool deck or in the immediate viewing area for the duration of the party.
4. Medical Consent
In the event of an emergency, I hereby authorize the staff of Champagne Swim Centre to seek medical treatment for the participant if I cannot be reached immediately. I confirm that the participant has no medical conditions that would prevent safe participation in swimming activities.
5. Photo Release (Optional)
Please select one:
Participant Name(s):
Age(s):
Parent/Guardian Name (Print):
Parent/Guardian Signature:
Date:
Emergency Contact Number:
