ENROLMENT FORM PUPIL/S FIRST NAME... SURNAME... DATE OF BIRTH... HOME ADDRESS... ADDRESS...

Transcription

1 Dear Parents, In order for your child to participate in swimming lessons at the pool at the Equestria Extension 31 Homeowners Association (NPC), you must sign this Membership Agreement, liability waiver and consent for medical treatment. ENROLMENT FORM PUPIL/S FIRST NAME... SURNAME... MALE... FEMALE... DATE OF BIRTH... HOME ADDRESS... ADDRESS... TEL: HOME (mother or guardian)... WORK (mother)... HOME (father)... WORK (father)... CELL PHONE (mother)... (father)... EMERGENCY CONTACT NAME... ALL TELEPHONE NOS PARENTS NAMES: Mother... Father.... CAN PARENTS/GUARDIAN SWIM?.... PREVIOUS SWIM SCHOOL LIST ANY MEDICAL CONDITIONS... FEARS OR BAD EXPERIENCES RELATING TO WATER......

2 EQUESTRIA EXTENSION 31 HOME OWNERS ASSOCIATION (NPC) (Registration Number: 2002/028113/08) A: ASSUMPTION OF RISK -, B: RELEASE OF LIABILITY - & C: INDEMNITY AGREEMENT D: CONSENT FOR MEDICAL TREATMENT THIS AGREEMENT CONTAINS PROVISIONS WHEREBY YOU SURRENDER CERTAIN LEGAL RIGHTS PLEASE READ CAREFULLY I, parent/guardian of the above mentioned applicant, hereby affirm that I understand that I am required to read carefully and sign an Assumption of Risk, Release of Liability & Indemnity against EQUESTRIA EXTENSION 31 HOME OWNERS ASSOCIATION (NPC) (Registration Number: 2002/028113/08) (herein after referred to as the Equestria Estate). A: I, hereby affirm that I am aware of and understand that swimming is a hazardous activity. I recognize that there are risks inherent in the sport of swimming, including, but not limited to: slipping and falling; drowning; collision with other persons, objects, or the pool s structure; broken bones; concussion; physical injury to muscles, tendons, and body parts; cuts or scrapes; pain or soreness; fatigue or exhaustion; cold or hot weather conditions; sunburn; dehydration; hypothermia (chill leading to a lowered body temperature); water ingestion; exposure to chemicals that burn the eyes and skin; insect bites; nausea; or death and I expressly assume the risk of said injuries. I understand and agree that neither the instructors conducting these activities, the facility through which this activity is conducted, nor the EQUESTRIA ESTATE, nor any of its Directors, respective employees, officers, agents or assigns (hereinafter referred to as Released Parties ) may be held liable or responsible in any way for any injury, death or other damages to my child, me, my family, our heirs or assigns that may occur as a result of my child s participation in this activity or as a result of the negligence of any party, including the Released Parties, whether passive or active. I further understand that swimming is a physically strenuous activity and that my child will be exerting him/herself during this activity and that if my child is injured as a result of heart attack, panic, hyperventilation, etc., that I expressly assume the risk of said injuries to my child. I affirm that I will not hold the above listed individuals or companies responsible for the same. In consideration of my child be allowed to participate in this activity I hereby personally assume all risks in connection with the activity for any harm, injury or damage that may befall my child while participating in the activity, including all risks connected therewith, whether foreseen or unforeseen.

3 B: I, on behalf of myself and my minor child, release, waive, and covenant not to sue the EQUESTRIA ESTATE, its Directors, members, managers, officers, employees, or agents with respect to any and all claims or causes of action that I or my child may have or which may hereafter accrue to my child or me on account of injury to his/her person or property, whether caused by the negligence of the EQUESTRIA ESTATE or otherwise, as a result thereof. This release is intended to discharge the EQUESTRIA ESTATE from any and all liability arising out of or connected in any way with my minor child s participation in the swimming lessons at the pool of the EQUESTRIA ESTATE C: I, on behalf of myself and my minor child, hereby agrees to indemnify and hold harmless the EQUESTRIA ESTATE, its Directors, members, managers, officers, employees, or agents against any liability resulting from any injury that may occur to my minor child while participating in swimming lessons at the pool of the EQUESTRIA ESTATE. I on behalf of myself and my minor child, also agrees to indemnify the EQUESTRIA ESTATE for any damages incurred arising from any claims, demand, action or cause of action by myself and on behalf of my minor child. The EQUESTRIA ESTATE assumes no responsibility for any personal property placed in or about the facility. D: The parent/guardian authorizes any representative of the EQUESTRIA EXTENSION 31 HOME OWNERS ASSOCIATION (NPC) to have the participant treated in any medical emergency during their participation in the swimming lessons. Further, the participant and/or parent/guardian agrees to pay all costs associated with medical care and transportation for the participant. I, PARENT/GUARDIAN, BY THIS INSTRUMENT DO EXEMPT AND RELEASE THE INSTRUCTORS CONDUCTING THIS ACTIVITY, THE FACILITY THROUGH WHICH THIS ACTIVITY IS CONDUCTED, THE EQUESTRIA EXTENSION 31 HOME OWNERS ASSOCIATION (NPC) AND ALL RELATED ENTITIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH, HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE.

4 I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS ASSUMPTION OF RISK, LIABILITY RELEASE & INDEMNITY AGREEMENT BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF, MY CHILD, AND OUR HEIRS. Signed: Date: (Parent/Guardian) Signed: Date: (Parent/Guardian) Parent: Home Phone Cell Phone: Work Phone Medical/Health conditions: E. GENERAL RULES: PLEASE MAKE SURE YOU HAVE READ AND UNDERSTOOD THESE RULES: 1. If I have to cancel the class for any reason it will be rescheduled / made up. NOTE: any cancellations must be made within at least 24 hours prior to each lesson. 2. Excuse your child from the lessons to be missed. A quick sms / WhatsApp will do ( ). 3. The monthly swimming fee is paid one month in advance by the last lesson of each month. Strictly no payment, no lesson. EFT: Please send proof of payment to management@equestria-estate.co.za

5 BANK FNB ACCOUNT NUMBER REFERENCE PLEASE USE REFERENCE ON INVOICE Note this contract is binding pending one month s written notice of termination. 4. Please put your child s swimming cap on their heads and blow snotty noses before classes. 5. Please keep siblings and friends out of the pool area while lessons are in progress. It is a distraction to the kids in the water. F: PARENTS PLEASE MAKE SURE YOUR CHILD HAS READ AND UNDERSTOOD THE FOLLOWING RULES WITH YOU: 1. Arrive on time for class dressed with your swimming cap on your head; or arrive 5 minutes early to change into your swimming gear in the changing rooms. 2. Go to the toilet and blow your nose before the lesson begins. 3. Wait quietly while the class before yours finishes. 4. Never get in the water without asking your teacher. 5. No running. 6. No eating or drinking around or in the pool. Eating before a lesson is not advised. It may cause discomfort or your child to feel sick. 7. Respect teachers and fellow swimmers; chat outside with friends while a class is in progress. 8. Respect our residential privacy demarcated by privacy and no entry signs on fences. 9. Take note of caution signs for your and your child s safety. 10. Strictly NO DOGS or any other pets allowed. G: DRESS CODE: Costume. Cap. Goggles. Towel. For all ages. All children are to wear a swimming costume and cap at all times. Silicone or material caps are easier to put on. Tying girls hair up first, makes it easier to put on.

6 Game and Mr Price Sport / any sport shop will sell caps and goggles. SAEKO, ZOGGS, SPEEDO are good brands - make sure the goggles are age appropriate, adult goggles do not fit children. Please use the changing rooms to change your child back into their clothes. Thank You. H: WHERE/WHEN AND COST? Lessons will take place at the Equestria Estate pool every Wednesday and Friday from 15h00. Lessons will be a 45 minute session. If students cannot make any of these times, lessons could be postponed to a different day but must be arrange by the trainer. I: Monthly rates are as follows: R per month for two 45 minute lessons per week. (children) R per month for two 45 minute lessons per week. (adults) R Registration fee is payable when joining Private lessons: Please contact Diyuti for further details. Certificates and report cards will be issued during the swimming season. Parents will be notified about swimming galas and fun days.