Waiver - Photo Release Form

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Donna’s Dolphins Registration/Waiver Referred by: Child’s Name: Child’s Name: Child’s Name: Mom’s Name: Dad’s Name: Home Phone: Email: Water Experience:

Address:

WAIVER RELEASE OF LIABILITY

Website Coupon Yellow Pages M/F Birthday: M/F Birthday: M/F Birthday: Mom Work #: Mom Cell #: Dad Work #: Dad Cell #: City: Zip: Special Needs:

WAIVER RELEASE OF LIABILITY

PLEASE READ CAREFULLY BEFORE SIGNING

This is a release of liability and waiver of certain legal rights. I, (please initial) , the parent/guardian of the participant(s) listed above agrees and understands that swimming is a hazardous activity. I recognize that there are risks inherent in the sport of swimming that includes but is not limited to paralyzing injuries and death. I hereby agree to allow the participant(s) listed above to participate in swimming activities and swimming classes at Donna’s Dolphins Swim School. I hereby agree to indemnify and hold harmless Donna Mallon and Donna’s Dolphins, its management, directors, agents and employees from any liability or from any damages that may occur to the participant while the participant is on the premises of Donna Mallon/Donna’s Dolphins. I also agree to indemnify Donna Mallon and Donna’s Dolphins for any damages incurred arising from any claims, demand, action, or cause of action by the participant(s). I hereby authorize any representative of Donna’s Dolphins to have the participant(s) treated in medical emergency during the participation at Donna’s Dolphins activities or swimming lessons, furthermore, I agree to pay all costs associated with medical care and transportation for the participant. Furthermore, I recognize that while swimming activities and swimming lessons are in session, the attention of Donna Mallon and representatives of Donna’s Dolphins, including agents and employees, are on the participant and the swim lessons. Accordingly, I hereby agree to indemnify and hold harmless Donna Mallon, Donna’s Dolphins, its management, directors, agents and employees from any liability resulting from any injury that may occur to myself or anyone else who attends the swim lessons as an observer. Furthermore, I agree to indemnify Donna Mallon and Donna’s Dolphins for any damages incurred arising from any claims, demands, actions, or causes of actions by any such observer. I HAVE CAREFULLY READ THE ABOVE INFORMATION AND SIGNED IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.

Parent/Guardian Signature: Parent/Guardian (please print):

Date: Date:

Parent/Guardian Signature:

Date:

PHOTO AUTHORIZATION I (please initial) hereby authorize Donna’s Dolphins Swim School to publish the photographs taken of me and/or the minor children listed above, and our names, for use in Donna’s Dolphins Swim School printed publications and website. I release Donna’s Dolphins Swim School from any expectation of confidentiality for the minor(s) listed above and myself and attest that I am the parent/legal guardian of the children listed above and that I have the authority to authorize Donna’s Dolphins Swim School to use their photographs and names. I (please initial) acknowledge that since participations in publications and websites produced by Donna’s Dolphins Swim School is voluntary, neither the minor child or I will receive compensation. I further agree that any participation in publication and website produced by Donna’s Dolphins Swim School confers no rights of ownership whatsoever. I release Donna’s Dolphins Swim School, its contractors and employees from liability from any claims by me or any third party in connection with my participation or the participation of the minor children listed above.