G:Forms/AgreementandReleaseForms/2016ReleaseofLiabilityForms/BirthdayPartyParticipationWaiver 1/25/16

BIRTHDAY PARTY PARTICIPATION WAIVER

Name of Birthday Child/Children________________________________

In consideration of your accepting my or my child’s participation in a birthday party package at the Greater Plymouth Community Center, I hereby for myself, my child, my heirs, executors and administrators waiver and release any and all rights and claims for damages I or my child may have against the Township of Plymouth, Plymouth Township Parks and Recreation Department, its officials and employees, and it’s representatives, successors and assigns for any and all injuries suffered by myself or my child and any activity sponsored by these groups. I agree to hold harmless and defend Plymouth Township, its officials, employees, successors and assigns, from any and all personal injuries and property damages sustained by others by reason of our participation in the Program. I understand that no health and/or accident insurance is provided by Plymouth Township. I accept full responsibility for obtaining the same or for the payment of all expenses in the absence of such insurance. I agree that Plymouth Township shall have the right to enforce activity rules and terminate participation for failure to comply. Likewise, I grant the right to use my/our name, image, photograph and video, including composite or modification representations in publications, brochures, newsletters, reports, websites, videos, social media and any and all other material relating to Greater Plymouth Community Center and all other Plymouth Township Parks and Recreational Facilities. I waive the right to inspect or approve versions of my/our image used for publication or the written copy that may be used in connection with the image. I fully release, indemnify and hold harmless Plymouth Township for any liability for actions taken on our behalf as well as for use of name or image as set forth herein.

Name of Participant (please print): _________________________________________________________________________ If Minor, Signature of Parent(s)/Guardian(s): _________________________________________Date:___________________ Name of Parent(s)/Guardian(s) (please print): _____________________________________ Phone #: ___________________ G:Forms/AgreementandReleaseForms/2016ReleaseofLiabilityForms/BirthdayPartyParticipationWaiver 1/25/16

BIRTHDAY PARTY PARTICIPATION WAIVER

Name of Birthday Child/Children________________________________

In consideration of your accepting my or my child’s participation in a birthday party package at the Greater Plymouth Community Center, I hereby for myself, my child, my heirs, executors and administrators waiver and release any and all rights and claims for damages I or my child may have against the Township of Plymouth, Plymouth Township Parks and Recreation Department, its officials and employees, and it’s representatives, successors and assigns for any and all injuries suffered by myself or my child and any activity sponsored by these groups. I agree to hold harmless and defend Plymouth Township, its officials, employees, successors and assigns, from any and all personal injuries and property damages sustained by others by reason of our participation in the Program. I understand that no health and/or accident insurance is provided by Plymouth Township. I accept full responsibility for obtaining the same or for the payment of all expenses in the absence of such insurance. I agree that Plymouth Township shall have the right to enforce activity rules and terminate participation for failure to comply. Likewise, I grant the right to use my/our name, image, photograph and video, including composite or modification representations in publications, brochures, newsletters, reports, websites, videos, social media and any and all other material relating to Greater Plymouth Community Center and all other Plymouth Township Parks and Recreational Facilities. I waive the right to inspect or approve versions of my/our image used for publication or the written copy that may be used in connection with the image. I fully release, indemnify and hold harmless Plymouth Township for any liability for actions taken on our behalf as well as for use of name or image as set forth herein.

Name of Participant (please print): _________________________________________________________________________ If Minor, Signature of Parent(s)/Guardian(s): _________________________________________Date:___________________ Name of Parent(s)/Guardian(s) (please print): _____________________________________ Phone #: ___________________

Swim Parties Only

Competent Swimmer? Yes No (Must wear US Coast Guard approved life vest at all times. Loaner vests available)

Critical Safety Rules (please review prior to the birthday party): • ALL CHILDREN 12 YEARS OF AGE & UNDER MUST BE SUPERVISED BY A PARENT OR GUARDIAN AT ALL TIMES. • All weak or non-swimmers must wear a US Coast Guard approved life vest and must be accompanied by a responsible adult or

guardian at all times. • Due to shallow water, diving is not permitted in the leisure or the shallow end of the lap pool. • All children not potty trained are required to wear a swim diaper under their bathing suit. Swim diapers are available at the front

desk. • Immediately notify a lifeguard or other GPCC staff member of any injury or unsafe conditions.

Swim Parties Only

Competent Swimmer? Yes No (Must wear US Coast Guard approved life vest at all times. Loaner vests available)

Critical Safety Rules (please review prior to the birthday party): • ALL CHILDREN 12 YEARS OF AGE & UNDER MUST BE SUPERVISED BY A PARENT OR GUARDIAN AT ALL TIMES. • All weak or non-swimmers must wear a US Coast Guard approved life vest and must be accompanied by a responsible adult or

guardian at all times. • Due to shallow water, diving is not permitted in the leisure or the shallow end of the lap pool. • All children not potty trained are required to wear a swim diaper under their bathing suit. Swim diapers are available at the front

desk. • Immediately notify a lifeguard or other GPCC staff member of any injury or unsafe conditions.