Viking Diving Club Membership and Registration Application - 2009

VIK9-_____________

Name___________________________________ Date of Birth_______________

Address_________________________________ Phone ( ) _______________

City________________________________ State_______ Zip Code____________

Club ( X ) Viking Diving Club Coach ( X ) Rick Carlson

Annual Membership Fee: $20.00 (make check payable to Viking Diving Club)

AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY

In consideration of being allowed to participate in any way in the Viking Diving Club athletics/sports programs, and related events and activities, the undersigned:

1. Agree that prior to participating, or in the case of a minor participant, the parent(s) or legal guardian(s) will instruct the minor participant that prior to participating, he or she should inspect the facilities and equipment to be used, and if the participant believes that anything is unsafe, he or she should immediately advise his or her coach or supervisor of such condition(s) and refuse to participate.

2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses might result not only from their own actions, inactions or negligence, but the actions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.

3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death.

4. Release, waive, discharge and covenant not to sue Viking Diving Club, its affiliated clubs, Homewood-Flossmoor High School, their respective administrators, directors, agents, coaches and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event, all of which are hereinafter referred to as "releases," from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise.

I/WE HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I/WE GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY.

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Athlete (Signature) Date

If athlete is less than 21 years of age and a resident of Colorado, Mississippi or Pennsylvania, or less than 19 years of age and a resident of Alabama, Nebraska or Wyoming, or less than 18 years of age and a resident of any other state, then the parent or legal guardian must also sign below.

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Parent or Legal Guardian (Signature/Relationship) Date

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Parent or Legal Guardian (Printed Name)