Pueblo Masters Swim Club Registration Form

Name _____________________________ Date of Birth (MM/DD/YYYY) __________________

COMSA Membership No. (Required) _______________________

Address ____________________________________________________________________                                                                

Daytime Phone ___________________     Alternate Contact Phone ______________________

Email (list all that we should send notifications to):

______________@______________    _______________@__________________

Medical issues we should be aware of: ______________________________________________

_____________________________________________________________________________

Swimmers must register with COMSA or USA Swimming in order to swim with the team.  COMSA is the source of the club’s insurance and provides benefits to you, including USMS Swimmer magazine.  COMSA registration is available from www.COMSA.org.

COMSA = Colorado Masters Swimming (age 18 and older) USA = United States Swimming (under age 18)

Pueblo Masters Swim Club Waiver and Release Agreement

In consideration for my being permitted to swim with the Pueblo Masters Swim Club, I agree to the following waiver and release:

I, the undersigned participant, acknowledge that swimming and volunteering to work in club activities have inherent risks, hazards and dangers.  I will not participate in Pueblo Masters activities unless I am medically able and properly trained.  I agree to abide by any decision of supervisory personnel on deck or in the pool relative to my ability to participate safely.  I assume all risks inherent in Masters Swimming (training and competition), including, but not limited to, drowning, falls, contact with other participants, the effects of weather, the conditions of the pool and facilities, injury, paralysis or death,  all such risks being known and appreciated by me.  As a condition of my participation in the Masters Swimming program or any activities incident thereto, I hereby waive any and all rights to claims for loss or damages, including all claims for loss or damages caused by the negligence, active or passive, of the following: Pueblo Masters Swim Club, United States Masters Swimming, Inc., local Masters swimming personnel, Pueblo School District No. 60, Pueblo School District No. 70, Colorado State University-Pueblo, and the City of Pueblo, their directors, officers, agents, employees, and volunteers.  In addition, I agree to abide by and be governed by the rules of USMS.

I, for myself, my heirs, successors, executors and subrogees, hereby knowingly and intentionally waive and release, indemnify and hold harmless parties named above from and against any and all claims, actions, causes of action, liabilities, suits, expenses (including reasonable attorneys' fees) and negligence of any kind or nature, whether foreseen or unforeseen, arising directly or indirectly out of any damage, loss, injury, paralysis, or death to me or my property as a result of my use of their pool and facilities, whether such damage, loss, injury, paralysis, or death results from negligence of said parties or from some other cause. 

This release is intended to be a comprehensive release of liability but is not intended to assert defenses which are prohibited by law.  I HAVE CAREFULLY READ, CLEARLY UNDERSTAND AND VOLUNTARILY SIGN THIS USE, WAIVER AND RELEASE AGREEMENT.

Signature ________________________________       Date of registration _________________

Dues (subject to change)

Annual membership fee is COMSA registration (required) – see above.

Pueblo Masters Swim Club fees (checks payable to “Pueblo Masters”):

Send to Heidi Gard, 552 East Earl Drive, Pueblo West, CO 81007.

          $60 Quarterly (due on the 1^st of Jan., April, July, & Oct.)

$30 monthly (due 1^st of each month)

$5 drop-in (Waiver signature required)

Scheduled swim times subject to change.  Check website at http://www.jonz.net/PuebloMasters/ .