Make checks payable to “Borough of Belmar”

BELMAR-Wall JR. GUARDLate REGISTRATION:Must be received by May 31st*Please remember to read and sign the waiver on back!*Child’s Name: ______________________________________________________________________LastBirth Date: _______________________ Age as of July 1st: ____________ Circle: Boy GirlFirstAddress: ___________________________________________________________________________Street______________________________________________ Phone: ______________________________CityState/ ZipEmergency Contact: ________________________________________________________________Name and phone numberEmail (Please print neatly!! ALL communication will be digital!!!):_____________________________________________________________________________________Imperative health information: _______________________________________________________Registration Fee: $65Circle T-shirt Size (adult sizes only): S M L XLMake checks payable to “Borough of Belmar”TOTAL: $65 Cash / Check #: ________________*Please remember to read and sign the waiver on back!*

2012 BELMAR-Wall JUNIOR LIFEGUARD PROGRAM & TOURNAMENTWaiver and Release of LiabilityIn consideration of participation in the Belmar Junior Lifeguard Program and/orTournament, the undersigned:1. Acknowledged and fully understands that each participant will be engaging inactivities that involve risk and injury to themselves.2. Assumes any and risks of personal injury to the minor and authorize the Boroughof Belmar to contact or render any medical treatment that may be deemednecessary for the minor. I (we) give authorization to a physician to treat orrender emergency medical treatment when necessary. If such medicaltreatment is necessary, I agree to pay all medical bills relating to injury arisingfrom participation in the event or activity.3. Release, waive, discharge, and convent not to sue the Borough of Belmar, TheBelmar Lifeguards, their respective administrators, directors, coaches and anyother employees or volunteers of these organizations, other participants,sponsoring agencies, sponsors, advertisers, and if applicable, owners and lesseesof premises used to conduct the event, all of which are hereinafter referred toas “releasees” from any and all liability, loss, damage, claim, demand, or causeof action against those attributable to the minor’s participation in the event oractivity, whether same shall arise by their negligence or willful or wantonmisconduct of one of those individuals or organizations.4. Warrant that the minor is in good health and has no physical condition thatwould prevent the minor from participation in the event or activity.I/We have read the above waiver and release, understand that we have given upsubstantial rights by signing it and sign voluntarily. I the parent/legal guardian, consentto the minor’s participation in the Belmar Junior Lifeguard Program and/orTournament._______________________________________________________________________Parent’s or Guardian’s SignatureDate