Swimmer’s Name: _____________________________________________ Age: ____________


Date of Birth _________Home Phone: ______________E-Mail _________________________


Home address: _________________________________________________________________


Father: ____________________________ work/cell phone: ____________________________


Mother: ___________________________work/cell phone: _____________________________

Since there is a need for volunteers to run the meets we host please check where you would be willing to help: Starter____Timer____Scorer____Awards____Runner____ Bull Pen____Announcer ____ Cook/concession stand helper____ Miscellaneous___ End of the Season Party____Coaches helper for entries for meets______

Waiver: I, the undersigned parent or legal guardian of ________________________________________ (minor child’s name), intending to be legally bound, hereby certify that my minor child is physically fit and has not been otherwise informed by a physician. I acknowledge that I am aware of all the risks inherent in swimming (training and competition), including possible permanent disability or death, and agree to assume all of those risks on behalf of my minor child.

In exchange of my minor child’s participation in the Summer League Swim Team activities sponsored or held by Macher Aquatic Center of Columbia, Missouri, I, the undersigned for myself, heirs, executors, agents, and assigns, waive, release and forever discharge Macher Aquatic Center, its coaching staff, directors, officers, agents, employees, representatives, volunteers, agents, successors and assigns of and from all rights and claims for damages, injury or loss to person or property which may be sustained or occur during the minor’s participation in the Summer League Swim Team activities, during transportation to and from such activities, and for any and all injuries sustained while receiving, and not receiving, or as a result of receiving medical treatment where such damages, injury or loss is due to ordinary negligence. The undersigned hereby expressly agrees to indemnify and hold harmless Macher Aquatic Center, I, the undersigned for myself, heirs, executors, agents, and assigns any and all costs and expenses incurred as a result of any claim for loss, injuries, or damages related to my minor child’s participation in said youth activities, including but not limited to , attorney’s fees, reasonable investigative and discovery costs, court costs, and all other sums which Macher Aquatic Center, assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of __________________________________________________________(child’s name) use of real property or personal property belonging to Macher Aquatic Center, its agents, servants, employees, officers, volunteers, and directors, or by action or omission of ______________________________________________(child’s name). Furthermore, the undersigned hereby expressly agrees that this release and waiver is intended to be as broad and inclusive as permitted by the laws of the State of Missouri and that if any portion hereof is held invalid, it is agreed that the balance shall; notwithstanding, continue in full legal force and effect.

BY MY SIGNATURE, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THIS AUTHORIZATION AND WAIVER.



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Signature of Parent or Guardian Date



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Print name

Turn in this application form with your check for $70 made payable to Macher Aquatic Center to Joanne Macher, Michael Laupp, or Mark Golden. Thank you.

Please list medical conditions/situations of which the coaches should be aware: