Youth & Aquatics Medical & Liability Release

Release Form

I/We ____________________________________________________ (being each Parent or Guardian listed below), for myself/ourselves and each child or ward of mine/ours (listed below) (collectively, “Users”), hereby execute and deliver this Release (”Release”) in consideration for the right and privilege of the Users to participate in any activity in or at The Briar Club (the “Club”), do, for myself/ourselves and my/our heirs, executors, administrators, legal representatives and assigns, hereby:

A. Acknowledge and agree that there are dangers and risks inherent in the use of equipment and other amenities at the The Briar Club and in participations in activities at The Briar Club and, therefore, agree to use the Club strictly in accordance with the safety instructions as instructed by the instructors/supervisors employed by the Club to monitor the use of The Briar Club. The Users further acknowledge and agree that the Club makes no warranties or representations concerning the design, manufacture or instructions for use of the Wellness and Recreation equipment and the Club hereby expressly disclaims any and all such warranties or representations, expressed or implied. The Club warrants only that the Wellness and Recreation equipment will be maintained by the Club in the manner prescribed by the manufacturer thereof. The Users further agree that their participation in any and all activities at The Briar Club is conditioned upon the Users’ strict compliance with the rules and instructions established by the Club for such activities.

B. ASSUME THE RISK OF AND THE FULL RESPONSIBILITY FOR, AND RELEASE, WAIVE AND DISCHARGE, AND AGREE TO INDEMNIFY AND HOLD HARMLESS , the Club and all of its directors, officers, employees and agents, acting in their respective capacities on behalf of the Club (collectively, the “Releases”) from any and all liability, loss or damage arising out of or from any personal injury to or death of Users and/or any thirdparty, and/or damage to the property of the Club, the Users, and/or any third-party, arising out of or relating in any manner to the Users’ use of The Briar Club and/or the Wellness and Recreation equipment, WHETHER CAUSED, IN WHOLE OR IN PART, BY THE SOLE OR CONCURRENT NEGLIGENCE, STRICT LIABILITY OR FAULT OF ANY ONE OR MORE OF THE RELEASEES AND REGARDLESS OF WHETHER ALLEGED TO BE OR ACTUALLY CAUSED IN COMBINATION WITH THE SAME OR SIMILAR CONDUCT BY ANY THIRD-PARTY.

Nothing herein shall constitute a waiver or release by the Users of (a) any claims or causes of action that Users may have against any third-party or parties, other than the Releases, arising out of or from injuries or damages to persons or property incurred by the Users in connection with their use of the Wellness and Recreation Equipment and/ or participation in any activity in The Briar Club where such injuries or damages are caused, directly or indirectly, by such third-parties; or (b) the Club‘s breach of its Warranty under paragraph A. PROVIDED, HOWEVER, IN NO EVENT WILL THE CLUB BE LIABLE TO ANY USER FOR CONSEQUENTIAL, EXEMPLARY OR PUNITIVE DAMAGES. ADDITIONALLY, PROVIDED THE CLUB MAINTAINS LIABILITY INSURANCE COVERAGE OF NOT LESS THAT $1,000,000, IN NO EVENT WILL THE CLUB’S LIABILITY TO A USER EXCEED THE LIABILITY INSURANCE COVERAGE MAINTAINED BY THE CLUB.

I/We certify that I/we have carefully read this Release, understand all of its terms, am/are signing it voluntarily and that I/we have the capacity and authority to sign on behalf of both myself/ourselves and each minor child or ward, if applicable.

CONTINUED ON BACK

Name of Each Applicable Minor Child/Ward Date of Birth Age Gender

Parent/Guardian (Printed): _____________________________________ Relationship: ___________________

Street Address: ___________________________________________ Phone #: _______________________

City: _____________________________ State: ____________ ZIP: __________ Date: _____________________

Member #: _________________________ Email Address: ___________________________________________

Parent/Guardian (Signature): ___________________________________________________________

MEDICAL INFORMATION & PERMISSION TO TREAT

Users hereby grant to the Club permission to take whatever action in its judgment may be necessary in supplying emergency medical services to each minor child or ward listed above. Users agree that Users will solely assume responsibility for and will pay promptly any expenses, which may be incurred by the Club in making emergency medical treatment to each minor child or ward listed above.

Parent/Guardian (Printed): ________________________________ Relationship: ________________________

Street Address: ______________________________________________ Phone #: _______________________

City: _______________________________ State: __________ ZIP: __________ Date: _____________________

Member #: _________________________ Email Address: ___________________________________________

Parent/Guardian (Signature): ___________________________________________________________________

Family Physician (Name & Contact): _____________________________________________________________

Medical Conditions/Allergies: __________________________________________________________________

Other Emergency Contacts

Name: ______________________________ Phone: __________________ Relationship: ___________________

Name: ______________________________ Phone: __________________ Relationship: ___________________

ADDITIONAL PERSONS APPROVED FOR DROP OFF/PICK UP

Name: ______________________________ Phone: _________________ DL #: ___________________________

Name: ______________________________ Phone: _________________ DL #: ___________________________