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Lifeguard Certification
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Email
Birthday of Student
Emergency Contact
Please list any allergies the student has. If the student has allergies, please provide details:
Last name
Phone
If under 18, please enter the name of the legal parent/guardian:
Emergency Contact Phone:
Please list any medical conditions the student has. If there are allergies, please provide details:
By clicking here: I have read and agreed to the following statement and terms: As the student, legal parent, or legal guardian, I release and hold harmless First to Respond L.L.C., its owner, employees, and operators from any and all liability, claims, demands, and causes of action whatsoever, that arising out of or related to any damage, loss, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the supervision and control of First to Respond L.L.C., its owners and operators or in route to or from any premises. In consideration of and through my involvement in the LifeguardCertification/Trainings offered by First to Respond L.L.C. at our training locations or any off-site location services are offered, I (or on behalf of my minor child), acknowledge and agree that I risk bodily injury, including paralysis, dismemberment, and death, as well as loss or damage to property. I knowingly and freely assume all such risk; and I (or on behalf of my minor child) for myself, and on behalf of my heirs, assigns and next of kin hereby release, hold harmless and promise not to sue First to Respond L.L.C. or any off-site training location/affiliate, the instructors of the program, or the persons involved in the facilitation of this program, with respect to all such injury, paralysis, dismemberment, death and/or loss or damage; with the except that which is resultant of gross negligence and/or willful or wanton misconduct. I certify that (or on behalf of my minor child) to be the best of my knowledge, I am in good physical condition and have no disease or injury that would impair my performance or result in my being injured during any program participation. In addition, I (or on behalf of my minor child) do hereby grant permission for duly authorize medical treatment by certified professionals to be administered to me (or my minor child) in the event of injury and that all costs are my responsibility. The above customer also agrees to allow First to Respond L.L.C. to use images or videos taken in any format, for use at any time, in any media, marketing, illustration, and promotional materials.
Sign here for Release of Liability, Medical Treatment Authorization, and Consent
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