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Registration
Participant Information
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Participant's Name
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Last
School
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Date of Birth
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Gender
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Female
Participant's Phone Number
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Participant's Address
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Participant's Email
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Parent/Guardian Information
Parent's Name
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School
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Parent's Phone
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Parent's Email
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Emergency Contact
Emergency Contact Name
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Emergency Contact Email
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Relationship
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Supplemental Information
Is there any information regarding you/your child that we should be made aware of, but have not asked on this form? If yes, please describe.
Comment
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Swim Affirmation
THE RISK OF DROWNING WHILE PARTICIPATING IN THE SPORT OF ROWING IS POSSIBLE.
Therefore, participation in rowing programs requires a swim affirmation be signed. The participant must be able to swim any stroke or combination of strokes for one length of a pool (50 meters) without interruption, immediately followed by a five minute period of floating or treading water.
I hereby affirm that I (my son/daughter/ward :: If under 18) can complete a 50 meter swim and float for 5 minutes as described above. Accordingly, I hereby release and discharge this program and its employees from all liability.
Choose One
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Yes, I (my son/daughter/ward) can swim and float for 5 minutes as described above
No, I (my son/daughter/ward) cannot swim and float for 5 minuted as described above
Name :: Parent/Guardian Name
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Date
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Medical Consent
I authorize the staff, coaching staff or authorized medical personnel to render any first aid or emergency treatment they deem reasonably necessary to my health and well-being.
Also, when necessary for executing such case, I grant permission for hospitalization and treatment at an accredited hospital.
I also understand that the coaches have the authority to eliminate or restrict me from further participation because of an injury or illness and/or because of undue liability risk.
Athlete Name
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Parent/Guardian Name
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Date
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Date
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Shared Responsibility for Sport Safety
Participation in sport requires an acceptance of risk of injury.
Athletes rightfully assume that those who are responsible for the conduct of sport have taken reasonable precaution to minimize such risk and that their peers participating in the sport will not intentionally inflict injury upon them. However, to legislate safety, via a rule book and equipment standards, while often necessary, seldom is effective by itself; and to rely on officials to enforce compliance with the rule book is as inefficient as to rely on warning labels to produce compliance with safety guidelines. “Compliance” means respect on everyone’s part for the intent and purpose of a rule or guideline.
I have read the above shared responsibility statement. I understand that there are certain inherent risks involved in participating in rowing. I acknowledge the fact that these risks exist and I am willing to assume responsibility for such risks while participating.
Athlete Name
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Parent/Guardian Name
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Date
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Date
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Waiver and Release
IN CONSIDERATION of being given the opportunity to participate in New York Rowing Association, Inc. Overpeck Lake Training and Regatta Center, River Rowing, and USRowing ("Sponsor") activities ("Activity") during the CALENDER YEAR 2020, I, for myself, my personal representatives, assigns, heirs, and next of kin:
1. ACKNOWLEDGE, agree and represent that I understand the nature of Rowing Activities, both on water and land based, and that I am qualified, in good health, and in proper physical condition to participate in such Activity.
2. FULLY UNDERSTAND that: (a.) ROWING ACTIVITIES INVOLVE RISKS AND DANGERS of serious bodily injury, including permanent disability, paralysis and death ("Risks"); (b.) these Risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or the negligence of the Releases named below; (c.) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the Activity.
3. AGREE AND WARRANT that I will examine and inspect each Activity in which I take part as a participant of the Sponsor and that, if I observe any condition which I consider to be unacceptably hazardous or dangerous, I will notify the proper authority in charge of the Activity and will refuse to take part in the Activity until the condition has been corrected to my satisfaction.
4. HEREBY RELEASE, discharge, and covenant not to sue USRowing, the Sponsor, their administrators, directors, agents, officers, volunteers and employees, other participating regatta organizers, any sponsors, advertisers, and if applicable, owners and lessors of premises, on which the Activity takes place, (each considered one of the Releases herein) from all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations; and I further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement, I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as a result of such claim.
5. Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. New York Rowing Association (“the Club”) has put in place preventative measures to reduce the spread of COVID-19; however, the Club cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Club could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Club and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Club or participation in Club programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.
I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.
Athlete's Name
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Date
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Phone Number
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Athlete's Address
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Parental Consent
AND I, (the minor's parent and/or legal guardian), understand the nature of rowing activities and the experience and capabilities and believe myself (the minor) to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue, and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses, or damages on the minor's account caused or alleged to be caused in whole or part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor's behalf makes a claim against any of the above Releases, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any may incur as the result of any such claim.
Participant/Parent's Name
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Date
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Phone Number
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Participant/Parent's Address
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Submit
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