Sports Club of Novi – Waiver

Your Name (required)

Current 2020 USMS Membership Number (required)

Street Address

City

State

Zip Code

Your Email (required)

Cell Phone Number (required)

Emergency Contact Name & Phone Number (required)

(Optional 2nd Emergency Contact Name & Phone Number

Doctor - Name and Phone Number (required)

Medical Insurance Company (required)

Insurance Subscribers 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.

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 acknowledge the inherent risks associated with 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); loss of or damage to personal property and equipment; and I hereby expressly assume all such Risks and responsibility for any damages, liabilities, losses or expenses that I incur as a result of my participation in any Events.

3. I hereby Release, Waive and Covenant Not to Sue, and further agree to Indemnify, Defend and Hold Harmless the following parties: The Sports Club of Novi, Milford Athletic Club (MAC), MAC coaching staff, its members, lifeguards, any pool facility and staff where a MAC swim takes place (the “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 attorneys’ fees) of any kind or nature (“Liability”) which may arise out of, result from, or relate in any way to my participation, including claims for Liability caused in whole or in part by the negligent acts or omissions of the Released Parties.

4. I further agree that if, despite this Agreement, I, or anyone on my behalf, makes a claim for Liability against any of the Released Parties, I will indemnify, defend and hold harmless each of the Released Parties from any such Liabilities which any may be incurred as the result of such claim.

5. COVID-19: I understand that participation carries with it risk of injury or death and I, on behalf of myself, my heirs, administrators, executors, and assigns expressly release, forever discharge, and hold harmless Milford Athletic Club (MAC), MAC coaching staff, its members, lifeguards, any pool or open water facility and staff where a MAC swim takes place (the "Releasees") for all personal injury, loss, damage to property, or death in connection with my participation. Further, I understand and acknowledge that there currently exists a global pandemic associated with the disease COVID-19, that I am participating at my own risk, that any safety precautions designed to protect against the spread of COVID-19 undertaken by the Releasees does not guarantee I will not contract COVID-19, and that, the foregoing notwithstanding, it is my specific intent to affirm my foregoing release of the Releasees with respect to any personal injury, loss, damage to property, or death I may experience from COVID-19 in connection with my participation.

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)

Δ