Please login and add some widgets to this widget area.
Your Name (required)
Current Year USMS Membership Number (required)
Your Email (required)
Cell Phone Number (required)
Emergency Contact Name and Phone Number (required)
Doctor - Name and Phone(required)
Medical Insurance Company (required)
Insurance Subscriber's Name
Insurance ID Number
Insurance Group Number
Insurance Authorization Phone Number
Pertinent Health or Medical Information and/or Instructions
You must ACCEPT the Waiver Below. By accepting the waiver, you agree to it's terms and conditions.
PARTICIPANT WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
For and in consideration of Milford Athletic Club (MAC, MAC L.L.C.) , MAC Coaching Staff/Event Organizers (the Released Parties) for allowing me, the undersigned, to participate in this voluntary swimming event, I, for myself, and on behalf of my spouse, children, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors, and assigns, hereby agree to and make the following contractual representations pursuant to this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement (the Agreement);
1. I hereby certify and represent that (i) I am in good health and in proper physical condition to participate in the Event; and (ii) I have not been advised of any medical conditions that would impair my ability to safely participate in the Event. I agree that it is my sole responsibility to determine whether I am sufficiently fit and healthy enough to participate in the Event.
2. I understand and acknowledge the risks and dangers associated with my participation the sport of swimming. I understand that my participation involves risks and dangers, which include, without limitation, the potential for serious bodily injury, sickness and disease, permanent disability, paralysis and death (from drowning or other causes); contact with other participants, spectators, animals or other natural or manmade objects; dangers arising from whether conditions; land, water and surface hazards; equipment failure inadequate safety measurements; participants of varying skill levels; and other undefined, not readily foreseeable and presently unknown risks and dangers. I understand that these Risks may be caused in whole or in part by my own actions or inactions, the actions or inactions of others participating in the courses, activities and events, or the negligent acts or omissions of Released Parties as defined below, and I expressly assume all such Risks and responsibilities for any damages, liabilities, losses or expenses which may be incurred as a result of my participation. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activity.
3. I UNDERSTAND THAT THE RELEASED PARTIES WILL NOT BE RESPONSIBLE FOR ANY MEDICAL COSTS ASSOCIATED WITH AN INJURY THAT I MAY SUSTAIN. I HEREBY RELEASE, WAIVE, AND COVENANT NOT TO SUE, AND FURTHER AGREE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS RELEASED PARTIES, WITH RESPECT TO ANY LIABILITY, CLAIM(S), DEMAND(S), CAUSE(S) OF ACTION, DAMAGE(S), LOSS OR EXPENSE (INCLUDING COURT COSTS AND REASONABLE ATTORNEY’S FEES) OF ANY KIND OR NATURE (“LIABILITY”) WHICH MAY ARISE OUT OF, RESULT FROM, OR RELATE IN ANY WAY TO MY PARTICIPATION IN THE EVENT, INCLUDING CLAIMS FOR LIABILITY CAUSED IN WHOLE OR IN PART BY THE NEGLIGENT ACTS OR OMISSIONS OF THE RELEASED PARTIES. I FURTHER AGREE THAT IF, DESPITE THIS AGREEMENT, I OR ANYONE ON MY BEHALF, MAKES A CLAIM FOR LIABILITY AGAINST THE RELEASED PARTIES, I WILL INDEMNIFY, DEFEND AND HOLD HARMLESS THE RELEASED PARTIES FROM ANY SUCH LIABILITIES WHICH MAY BE INCURRED AS THE RESULT OF SUCH CLAIM.
This Agreement shall be governed by and construed under the laws of the State of Michigan. I agree that any legal action or proceeding relating to this Agreement, or arising out of any injury, death, damage or loss as a result of my use of Facility, shall be brought only in Oakland County, Michigan.
I hereby warrant that I am of legal age and authorized to enter into this Agreement, that I have read this Agreement carefully, understand its terms and conditions, acknowledge that I will be giving up substantial legal rights by signing it (including my rights and the rights of my heirs and next of kin and any legal and personal representative, executors, administrators, successors and assigns), acknowledge that I have signed this Agreement without any inducement, assurance or guarantee, and intend for my signature to serve as confirmation of my complete and unconditional acceptance of the terms, conditions, and provisions of this Agreement. This Agreement represents the complete understanding between the parties regarding these issues and no oral representations, statements, or inducements have been made apart from this Agreement. If any provision of this Agreement is held to be unlawful, void, voidable, or for any reason unenforceable, then that provision shall be deemed severable from this Agreement and shall not affect the validity and enforceability of any remaining provisions.
I hereby warrant that I am of legal age and competent to enter into this Agreement, that I have read this Agreement carefully and my acceptance of this is acknowledged.
CLICK BOX TO ACCEPT THIS AGREEMENT (required)