Registration Information

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Class Meeting Dates: Oct. 12, 19, 26, & Nov. 2, 9, 16

Class Meeting Times:  5:00 – 5:45pm

First Name *

Last Name *

Campus/Building *

---Administration BuildingAdministration AnnexFood ServicesSpecial Ed AnnexTransportationFacilities ServicesCliftonKinkeadePierceBartonBrandenburgBritainBrownElliottFarineGilbertGoodJohn HaleyThomas HaleyHanesJohnstonKeyesLeeLivelySchulzeStipesTownleyTownsellAustinBowieCrockettDe ZavalaHoustonJohnsonLamarTravisCardwellIrvingMacArthurNimitzSingley AcademySingley Collegiate AcademySouth Irving Collegiate AcademyOther

Address *

State *

Zip *

Phone *

Email *

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PARTICIPATION WAIVER AND HOLD HARMLESS AGREEMENT

I, the undersigned, acknowledge, agree, and understand that, voluntarily and of my own free will, I am electing to participate in the Irving ISD Adult Learn-to-Swim Program (“Swim Program”). I understand that participation in the Swim Program is not part of my job duties with Irving ISD and I acknowledge that I am not required to nor have I been pressured to participate in the Swim Program by my employer. I understand that the activities of the Swim Program come with certain risks and hazards that may result in injury or death to me or other participants in the Swim Program or property damage. I am not aware of any physical or medical conduction that would interfere with my ability to participate in the Swim Program. IN CONSIDERATION FOR MY PARTICIPATION IN THE SWIM PROGRAM, I HEREBY RELEASE AND DISCHARGE IRVING ISD AND ITS EMPLOYEES, OFFICERS, AGENTS, AND VOLUNTEERS FROM ANY AND ALL CLAIMS FOR PERSONAL INJURY, DEATH, OR PROPERTY DAMAGE ARISING FROM OR IN ANY WAY CONNECTED WITH MY PARTICIPATION IN THE SWIM PROGRAM, INCLUDING, WITHOUT LIMITATION, FOR INJURY, DEATH, OR PROPERTY DAMAGE RESULTING FROM A WRONGFUL ACT, OMISSION OR NEGLIGENCE.

IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT I HAVE READ AND UNDERSTAND THE TERMS IN IT, AND THEIR LEGAL SIGNFICANCE. I FURTHER ACKNOWLEDGE AND REPRESENT I SIGN THIS AGREEMENT KNOWINGLY AND VOLUNTARILY.

Signature *

I, the participant and/or the legal guardian, agree entirely to the information above.

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Today's Date *

Health Concerns *

Please list out all health concerns, if none: (N/A)