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Adults Liability Waiver Form (PDF)

The document is a liability waiver for adults participating in programs at the City of Willits Pool. Participants acknowledge the risks of physical injury and agree to release the City of Willits from any claims related to injuries or damages incurred during the programs. It also includes sections for personal information and emergency contact details.

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Dank Mukund
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3 views

Adults Liability Waiver Form (PDF)

The document is a liability waiver for adults participating in programs at the City of Willits Pool. Participants acknowledge the risks of physical injury and agree to release the City of Willits from any claims related to injuries or damages incurred during the programs. It also includes sections for personal information and emergency contact details.

Uploaded by

Dank Mukund
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CITY OF WILLITS – Pool Liability Waiver – ADULT

Full Name: ___________________________________________________


Address: _____________________________________________________
Phone: _______________________________________________________
Email: _______________________________________________________

EMERGENCY CONTACT:
Name: _______________________________________________________
Phone: _______________________________________________________
Medications: __________________________________________________
Allergies: _____________________________________________________
Doctor’s Name & Phone: _______________________________________

Release of Liability
Please be aware that in registering yourself for participation in the program(s) at City Of Willits Pool,
you will be waiving and releasing all claims for injuries you might sustain arising out of the
program(s). I recognize and acknowledge that there are certain risks of physical injury to participants
in the program(s) and I agree to assume the full risk of any such injuries, damages, or loss regardless
of severity which I sustain as a result of participating in any of the program(s). I hereby fully release
and discharge the City of Willits and its officers, agents, servants and employees from any and all
claims resulting from injuries, damages and losses sustained by me, and arising out, connected with, or
in any way associated with activities of any of the programs. Please allow lifeguards to administer
first aid during classes, public swim, and pool parties.

Signature: _________________________________________________

Date: _________________

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