Name *

Name of person filling out form.

First Name

Last Name

Home Address *

Address 1

Address 2

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Liability Disclaimer *

I recognize that there are certain inherent risks of physical injury to patrons of aquatics facilities, and I voluntarily agree to assume the full risk of any injuries, damages or loss, regardless of the severity that my child or I may sustain as a result of participating in any and all activities/programs connected with Smoketree Pool. I hereby acknowledge and agree that my or my child’s use of the facilities of Smoketree Pool, including the pool, game pool, baby pool, pool deck, bathrooms, basketball court, sand volleyball court and pavilion area may be dangerous and creates the potential for personal injury, including but not limited to drowning, injury from diving, slipping or sliding on wet surfaces or falling. With regard to the facilities, which I use, I agree to exercise caution for my own safety and that of my child’s, and to inspect such facilities prior to use thereof in order to insure that they are secure and safe for the use as I intend to make of them. I hereby acknowledge the potential for injury from the use of Smoketree’s facilities and assume the risk thereof, and in addition, I agree to indemnify and hold Smoketree and all personnel (including but not limited to directors, volunteers and employees) harmless for any injury or damage caused by my use of such facilities. I hereby acknowledge that I have read and understand the rules and requirements as described and listed on Smoketree Pool Policies document and agree to abide thereof. I hereby acknowledge that I have read and understand the terms of this Release and sign it of my own free will and act. Please indicate you have fully read and understand the above message.

Yes, I have read and understand

No, I have not read or do not understand