CITY OF HOMESTEAD
PARKS, RECREATION AND OPEN SPACES DEPARTMENT
SWIMMING PROGRAM
WAIVER AND MEDICAID AUTHORIZATION FOR MINORS
(To be completed by Parent or Guardian)
As the parent or legal guardian of
Please enter child name.
, a minor child participating in programs, activities, or using any facilities,
premises, or equipment operated, managed, or sponsored by the City of Homestead,
One Stop Aquatic Safety LLC ., and Miami Lifeguards LLC ., I hereby
agree to the
following terms and conditions:
1. Waiver and Release: I voluntarily waive, release, and discharge any and all claims for
damages for personal injury, property damage, or wrongful death which may arise from or
relate to the participation of the above-named minor in any program, activity, event, or use
of facilities, equipment, or transportation provided, organized, or endorsed by the City of
Homestead, One Stop Aquatic Safety LLC ., and Miami Lifeguards
LLC ., including their
elected and appointed officials, employees, agents, contractors, volunteers, and
representatives (collectively, the “Indemnitees”), regardless of whether such injury or
damage is caused in whole or in part by the negligence of the Indemnitees.
2. Medical Authorization: I authorize the Indemnitees and their agents to seek emergency
medical treatment for the above-named minor and to transport or arrange for transport of
the minor to an appropriate medical facility if, in their judgment, medical treatment is
necessary, and the parent or guardian cannot be contacted in a timely manner. I understand
that the Indemnitees assume no responsibility for the medical care or transportation
provided, and I agree to be financially responsible for any resulting medical charges.
3. Acknowledgment of Responsibility: I understand that the City of Homestead, One Stop
Aquatic Safety LLC ., and Miami Lifeguards LLC . are not responsible
for the loss of personal
items, including money, and that participants are discouraged from bringing valuables to
programs, activities, or events.
4. Photo and Media Release: I grant permission to the City of Homestead, One Stop
Aquatic
Safety LLC ., and Miami Lifeguards LLC ., and their authorized
representatives to photograph,
video record, and otherwise capture the likeness of the above-named minor during participation
in
any program, activity, or event. I further authorize the aforementioned parties to use such
images,
video, or audio recordings in promotional materials, publications, social media, websites, and
other
media outlets promoting their programs, activities, or initiatives. I understand that no
compensation
City of Homestead
Parks, Recreation & Open Spaces Department
Swimming Program
will be provided for such use and that all images and recordings shall become the property of
the
City of Homestead, One Stop Aquatic Safety LLC ., and Miami Lifeguards
LLC ..
Signature of Parent or Guardian:
Please sign the waiver before submitting.
Clear
Printed Name:
Please enter name.
Date:
Please select date.
By signing this form, I certify that I am the parent or legal guardian of the above-named
minor and that I have read, understood, and agreed to all terms and conditions contained in
this Waiver and Medical Authorization. I understand that my electronic signature shall have
the same legal effect as a handwritten signature
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