RELASE FROM LIABILITY
In consideration of the acceptance of my child’s application, as a participant in the Junior Lifeguard Program, I hereby agree to assume all risks attendant upon my child
while participating in the Junior Lifeguard program. I understand and acknowledge that the ocean and beach are unpredictable and inconsistent environments and that these
activities, by their very nature, pose the potential risk of serious injury/illness or death to individuals who participate. I hereby waive, release, and discharge any and
all claims for damage for death, personal injury or property damage which my child may have, or which may hereafter accrue to my child, as a result of my child’s participation
in the Junior Lifeguard Program. I agree to save and hold harmless from liability Corolla Lifesaving Association, Inc., Corolla Beach Rescue, Inc., the county of Currituck,
all sponsors, their representatives and successors and/or any of their officers, agents, volunteers, or employees by reason of accident, death, injury, or damages to persons
or property which my child may suffer while participating in the Junior Lifeguard Program. This release is intended to discharge in advance Corolla Lifesaving Association, Inc.,
the county of Currituck, all sponsors, their representatives and successors and/or any of their officers, agents, volunteers, or employees by reason of any accident, death,
injury, or damages to persons or property which my child may suffer from and against any and all liability arising out of or connected in any way with my child’s participation
in the Junior Lifeguard Program, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above.
I further understand that serious accidents or death can occur during aquatic and marine activities; and that participants in aquatic and marine activities occasionally
sustain mortal or serious personal injuries, and/or property damage, as a consequence thereof. Knowing the risk of aquatic and marine activities (swimming, surfing, lifesaving,
bodysurfing, kayaking, and the like) nevertheless, I hereby agree to assume on behalf of my child those risks and to release and hold harmless all of the persons or entities
mentioned above who (through negligence or carelessness) might otherwise be liable to my child (or my child’s heirs or assigns) for damages. It is further understood and agreed
that this waiver, release and assumption of risk is to be binding on the heirs and assigns of my child. I agree to assume all responsibility for any property damage or injury
to any person caused by my child while participating in the Junior Lifeguard Program.
VIDEO - PHOTO RELEASE
I understand that during the Junior Lifeguard program or related activities, my photograph and/or the photograph of my child may be taken by the Junior Lifeguard Program
producers, sponsors, organizer, and/or assigns. I agree that my photograph and/or the photograph of my child, including video photography, film photography, or other reproduction
of my likeness or the likeness of my child may be used without charge by the Corolla Lifesaving Association, Inc., its producers, sponsors, organizers, and/or its assigns
for educational, promotional, and/or other necessary purposes.
AUTHORIZATION TO TREAT A MINOR
I, the parent or legal guardian of the child referred to herein, do hereby authorize and consent to any x‐ray examination, anesthetic, medical, or surgical treatment rendered
under the general or special supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medical Practice Act or a dentist
licensed under the provisions of the Dental Practice Act and on the staff of any acute general hospital or emergency care facility holding a current license to operate a hospital
or emergency care facility. I understand that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide
authority and power to render care which the aforementioned physician, in the exercise of his/her best judgment, may deem advisable for my child. Further, I understand my child
will be participating in inherently dangerous activities (swimming, surfing lifesaving, canoeing, and the like) and agree to pay for my child’s medical expenses. I understand
that all effort shall be made to contact me prior to rendering treatment to my child, but any of the above treatment will not be withheld if I cannot be reached. This consent
shall remain in effect until the end of the Junior Lifeguard Program session in which my child is enrolled.
There is a $20.00 fee for cancellation made prior to the first day of instruction. After the second day, no refunds will be made. Corolla Lifesaving Association, Inc. reserves the
right to deny acceptance to any child who it deems to not meet the following prerequisites: (1) able to complete a 25 yard swim in the pool unassisted and, (2) being comfortable
in the ocean at the time of the start of the program. If this were to occur, you would receive a full refund minus the $20 processing fee. There are no refuds due to bad weather
such as rain or thunderstorms.
By checking this box I certify that my child is physically fit to participate in the Junior Lifeguard Program, and meets the required prerequisites.
The ability and prerequisites checkbox is required.
By checking this box I understand that my child is strongly encouraged to wear the provided uniform rash guard during Junior Lifeguard activities.
The use of rashguard checkbox is required.
By checking this box I have read, understand, and accept the terms and conditions of the REFUND POLICY.
The refund policy checkbox is required.
By checking this box I have read, understand, and accept the terms and conditions of RELEASE FROM LIABILITY and the VIDEO‐PHOTO RELEASE.
The liability and video-photo release checkbox is required.
By checking this box I have read, understand, and give authoriztion and permission under the terms of the AUTHORIZATION TO TREAT A MINOR.
The authorization to treat a minor checkbox is required.
By checking this box I attest that to the best of my ability, all of the inforamtion above is true and accurate, and I understand that if I
do not understand and agree to the terms and conditions set forth above Corolla Lifesving Association, Inc. and the Junior Lifeguard Program
will not be able to process my child’s application.
The terms and conditions checkbox is required.