RELEASE AND WAIVER OF LIABILITY

THISFORMISANIMPORTANTLEGALDOCUMENTTHATAFFECTSYOURLEGALRIGHTS.PLEASEREVIEWITFULLYANDCAREFULLY. YOURCHILDMAYNOTPARTICIPATEINTHEPROGRAMUNTILYOUHAVETHOROUGHLYREVIEWEDANDSIGNEDTHISAGREEMENT. INCONSIDERATIONofallowing,_______________________________________,aminorchild,toparticipateinSurvivalSwimlessons. TheundersignedParentorLegalGuardianherebyagrees,bothindividuallyandonbehalfoftheminorchild,asfollows: I represent that I/we, _______________________/______________________________, am/are the Parent(s)and/or Legal Guardian(s)of_______________________________ (Minor(s))andI agree thatthegrants,releasesandothertermscontainedinthisAgreementbindme,theMinor,andustogethertoallofthetermsofthisAgreement. I hereby acknowledge that PARTICIPATING IN SWIM LESSONS COULDRESULTINSERIOUSBODILY INJURY,PERMANENTDISABILITYORDEATHANDAMFULLYAWAREOFAND WILLINGLY ACCEPTSUCHRISKS,HAZARDS,ANDDANGERSBOTHINDIVIDUALLYANDONBEHALFOFTHEMINOR. I hereby agree to: (i) release and forever discharge Ashley Lopez, Julia Daum, John Daumtheir agents, servants, employees, independent contractors, officers, directors, trustees, owners and all other persons or entities acting on its behalf together with the owner(s) and/or lessor(s) of thePremises andtheiragents,servants,employees,officers,directors,trusteesand allother persons orentities acting ontheirbehalf(collectively,theCoveredParties),from any andallclaims,actions,damages,liability,costs orexpensesand attorneysfeeswhichare relatedto,ariseoutof,orareinanyway connected to the Parent or Legal Guardian and/or the Minor participating in Survival Swim Lessons, whether or not such claims, actions, damages, liability, costs or expenses are caused by the negligence of a Covered Party or any other attendee or participantintheSwimLessons, orotherwise, (ii) surrenderandwaiveanyrightsthattheParent orLegalGuardianand/ortheMinor, heirs, next of kin, family, relatives, guardians, executors, administrators, trustees and assigns may have or possessto sueorexerciseanyremedyorlegalright toseekdamagesfromanyCovered Party for any such claims, actions, damages, liability, costs or expenses and (iii) indemnify, hold harmless and defend each Covered Party from any and all claims, actions, damages, liability, costs, expensesandattorneyfeesthatarerelatedto,ariseoutof,orareinanywayconnectedtotheParent/LegalGuardianand/ortheMinorparticipatingintheSurvivalSwimlessons. I agree to hold the instructors, Ashley Lopez, and property owner(s) Julia and John Daumharmlessfrom anyliability resultingfromtheuseofthepremisesoffered forlessons.Iagreetobesolelyresponsible forthecareofmychildwhileoutofthewaterandsolelyresponsibleforthecareofanychildIhavebroughttothepoolwithme. I hereby give my consent and permission tothe Instructor, Ashley Lopez,and her representatives, as necessary in theirdiscretionand judgment,toobtainonmybehalfany emergencymedicalattentionand treatment in case of sickness, accident, or injury and to secure such medical attention and treatment at my sole expense and hereby agree to indemnify,holdharmless andreimburse the instructor and/or homeowners and/or its representatives or instructors including but not limited to Julia Daum and/or John Daum all costs and expenses that are related to, arise out of, or are in any way connectedtoanyemergencymedicalattentionandtreatmentincaseofsickness,accident,orinjuryfortheMinor.

I HEREBY CERTIFYTHATI AMOVER 18 YEARSOF AGEANDTHAT I HAVECAREFULLY READ ANDUNDERSTANDTHISENTIREAGREEMENTANDAGREETOALLOF THE ABOVE TERMS AND CONDITIONS. PRIOR TO SIGNING THIS AGREEMENT I HAVE HAD THE OPPORTUNITY TO ASK ANY AND ALL QUESTIONS ABOUTTHE LESSONS, PARTICIPATIONIN THEISR PROGRAM, AND/OR THIS AGREEMENT.I AMAWARETHATBY SIGNING THIS AGREEMENT, I ASSUMEALLRISKSANDWAIVE AND RELEASE CERTAIN SUBSTANTIAL RIGHTS THAT I, MY HEIRS, NEXT OF KIN, FAMILY, RELATIVES, GUARDIANS,EXECUTORS,ADMINISTRATORS, TRUSTEES, AND ASSIGNSMAY HAVEOR POSSESS AGAINST ASHLEY LOPEZ AND/OR JULIA DAUM ORJOHN DAUM OR ANY OTHER COVERED PARTYFORDAMAGEORHARM ARISINGFROMOROCCURRINGAT,DURINGORINCONNECTIONWITHMYPRESENCEATORPARTICIPATIONINSURVIVALSWIMLESSONS.
Mother and/or Legal Guardian Name:___________________________________ Signature:___________________________________ Address:___________________________________ ___________________________________ Phone:______________[Home]__________________[Cell] Father and/or Legal Guardian Name:___________________________________ Signature:___________________________________ Address:___________________________________ ___________________________________ Phone:______________[Home]__________________[Cell] MinorChild(ren) Name(s):_______________________________ Date(s)ofBirth:______________________________ Age(s):_______________________________