Water Polo Clinic

PARENTAL MEDICAL AUTHORIZATION AND ASSUMPTION OF RISK

In consideration of my child or children (“children”) being allowed to participate in the activities, programs, events, or services provided by Phantom Lake Bath and Tennis Club (PLC) (collectively, “Activities”) and permitted access to PLC facilities, I agree as follows:

I voluntarily agree to assume all risks involved in my children’s participation, and consent to my children’s participation in the Activities.

In the event of accident, injury, illness, or an emergency where I cannot be reached, I hereby authorize PLC, its directors, coaches, employees and the treating physician to obtain or provide what medical treatment is deemed necessary for the immediate welfare of my children. I will be responsible for any payment of fees or costs associated with such treatment.

I understand that there are both foreseeable and unforeseeable risks of injury or death that may occur as a result of my children’s participation in the Activities that cannot be specifically listed. Further, I recognize that the actions of other users of PLC’s facilities may cause harm or loss to my children’s person or property. I release PLC and its directors, officers, employees, or agents (“PLC”) from any and all liability, claims, costs, expenses, injuries or losses, including those resulting from acts of negligence by PLC, that I or my children may otherwise sustain as a result of my children’s participation in the Activities. I further agree that if, despite this Parental Medical Authorization and Assumption of Risk, my children, I, or anyone on my or their behalf, makes a claim against PLC, I will defend, indemnify, save and hold harmless PLC from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.

If any part or portion of this Parental Medical Authorization and Assumption of Risk is found to be invalid or unenforceable, then the remainder will continue in full force and effect and any invalid portion will be modified or partially enforced to the maximum extent permitted by law to carry out the intention of this Parental Medical Authorization and Assumption of Risk. I have carefully read this Parental Medical Authorization and Assumption of Risk and fully understand its contents.

By signing as the parent or guardian of my children, I represent that I am the legal parent or guardian of the children. I acknowledge that I am also signing this Parental Medical Authorization and Assumption of Risk on behalf of my children and that the children shall be bound by the terms of this Parental Medical Authorization and Assumption of Risk. I am aware that this Parental Medical Authorization and Assumption of Risk is a contract between PLC and myself and on behalf of my children, I sign it of my own free will.