Acquaworld

ACQUAWORLD REGISTRATION FORM

PERSONAL DATA: Participant

Name

Age

Date of Birth

Sex

Address

FAMILY DATA:

Father's name

PHONE NUMBERS:

Phone

Ofi

Mobile

Mother's name

PHONE NUMBERS:

Home

Ofi

Mobile

MARK THE WEEKS IN WHICH YOUR REPRESENTATION WILL PARTICIPATE

Checkbox Field

DAY CAMP

NIGHT CAMP

SPRING BREAK

SUMMER CAMP

PEOPLE AUTHORIZED TO PICK UP THE PARTICIPANT: (Place name and last name)

(No participant could be withdrawn if the person is not authorized in this form)

MEDICAL RECORD

Does the child have a physical disability or illness?

Is the child allergic to any medication and/or food?

Does the child take some type of medication?

Name of the child's doctor:

Phones: Office:

Celular:

Office address

Place where you would like your representative to be transferred in case of an emergency:

Credit Card Authorization

Type of Credit Card:

Security Code

Name as it appears on the card:

Credit Card Number:

Expiration date

Phone Number of Cardholder

Billing Address of Cardholder

I authorize that the debit be made according to the program.

Date

GENERAL CONDITIONS

1. Summercamp / Springbreak / Day camp will not allow objects or appliances that are not requested or required in the registration form or in any communication specially issued in this regard therefor the organization will not be responsible for the loss or total or partial damage of any of the objects described above and will not be at any time cause for complaint by Parents or Guardian.

2. The accessories that the parents deem convenient to send for the well-being of their representative, must be notified in writing to the Management of the program. Still, we will not be responsible for those, nor for the money that the kids carry.

3.It is strictly mandatory, that each kid brings all his clothing identified with his name, both the uniform and other accessories. This mark must be placed on the inside of it.

4. The parents and (or) guardian, will be able to observe the activities that the children realize, as long as they do not interfere with it.

5. The parents and (or) guardian will be strictly forbidden to exceed the safety limits established by the staff of the summercamp in the different areas such as: dining room, fields, special activities, swimming pools, among others.

6. Once the payment is made, the parents and (or) guardian will not be entitled to the refund of the money. Under no circumstances (this includes absence due to illness, suspension due to inappropriate behavior, problems of adaptation, if you arrived late to the fieldtrip departure or any other reason).

7. The Parents and (or) guardian must inform the Director in writing, the contraindicated medications for the kids, as well as their medical history, allergies and any other information considered necessary and indispensable in case of an emergency.

8- The parents and (or) guardian will accept that any other expense that derives from illness or accident of the kids, not covered by the referred policy must be paid by them.

9. The parents and (or) guardian will accept that the admission and permanence of the kids within the place is subject and expressly conditioned to it complying with all the rules, policies (conditions), and camp order practices.

10. The participant will not be allowed to attend the weekly fieldtrip if he does not bring the uniform. Under no circumstances will it be allowed, for reasons of extreme security

11. Under no circumstances will children be received at the place of the fieldtrip, if the kid does not arrive at the scheduled time to leave. If the minor does not attend the fieldtrip, he should be taken to the facilities of the summercamp only when the rest of the group arrives.

12. The distribution of the children will be made by age groups and level of development that in the opinion of the summercamp manager is considered for the shelter of the camper and the group. Under no circumstances may parents interfere in this decision.

13. Under no circumstances will the campers be allowed to enter the summercamp without their representative.

14. It is mandatory that parents sign the children’s attendance on a daily basis both at the entrance and at the exit.

15. The Summercamp will be responsible for its representative starting at 8:00 a.m. until 5:00 p.m. The permanence of the same in the camping outside the established schedules, will cause a fine of $ 10 for every 15 minutes of delay.

RESIGNATION AND RELEASE OF LIABILITY

I, the undersigned, understand that participation in swimming classes / swimming activities involves a risk of accidental injury, despite all safety precautions. I hereby release Acqua World Swim Academy, its officers, agents, employees and volunteers and PV International Sports Kid, from all liability or claims that may be sustained by the participant named here, or a third party directly or indirectly in relation to, or arising from, of participation in the activity described in this document, whether caused, in whole or in part, by the negligence of Acqua World, PV International Sport Kids or otherwise. I certify that the named participant is fully covered by medical insurance and that I am fully responsible for all costs incurred. I further certify that the previous participant is in good health and free of injury.

INITIALS:

As a parent / legal guardian, I give consent for my minor to receive first aid by center staff and emergency service directions, and if necessary, be transported and receive emergency service. I understand that I will be responsible for all costs not covered by my health insurance.

INITIALS:

I give consent to all people on this emergency contact list to act on my behalf until I am located. I understand that it is my responsibility to review and update this information when any changes are made.

INITIALS:

As a parent / legal guardian I authorize Acqua World Swimming Academy and PV International Sport Kids to use and display the images in which my minor appear in activities, competitions, etc. carried out within their facilities or in which they attend with the same, and the companies may published on social networks.

INITIALS:

Legal guardian of

expressly agree and accept all the clauses and conditions stablished by the Camping Organizing Committee, and based on them, I register my kid being understood that no claim subsequent to the signing of this agreement will be taken into consideration. Therefore, the complains related directly or indirectly to the content of some of the clauses described above, will not have support or validity.

Signature of the Representative:

Father’s signature:

Mother’s signature:

Important note: Registration of the participant will not be effective if this form is not duly signed by the parent or representative. No exception

ATHLETIC WAIVER OF LIABLITY AND HOLD HARMLESS AGREEMENT

parent/legal guardian (the “Parent”) of

(the “Player”) with DOB

hereby voluntarily sign this FULL RELEASE AND HOLD HARMLESS, with the understanding that there are certain inherent risks associated with participating in sports and/or athletic training that cannot be eliminated. These risks include but are certainly not limited to: (1) minor injuries such as scratches, cuts, bruises and strains; and (2) major injuries such as injuries to the eyes, infection, loss of sight, joint injuries, back injuries, heart attacks, concussions, paralysis and even death. Also included in these risks are the same or similar injuries that might result from using training equipment, actual use of a field or training facilities, the acts of others or from the unavailability of emergency staff or emergency medical care (hereinafter we shall define all of these risks and potential injuries as “Risks”). All of these Risks will be present in the activities that you and/or your minor will be participating with PV INTERNATIONAL SPORTS KIDS LLC (the “Activities”). I further;

INITIALS:

I hereby release PV INTERNATIONAL SPORTS KIDS LLC and its representatives, affiliates, officers, agents, employees, members, directors, volunteers, and attorneys, from any and all liability or claims that may be sustained by the Player, or a third party directly or indirectly in relation to, or arising from, Player’s participation in the activity described in this document, whether caused, in whole or in part, by the negligence of PV INTERNATIONAL SPORTS KIDS LLC or otherwise, including any responsibility for recruitment not allowed during the current sport season.

INITIALS:

I certify that the Player is fully covered by medical insurance and that I am fully responsible for all costs incurred, whether covered by a policy or not. I further certify that Player is in good health and free of injury.

INITIALS:

I understand that there are certain inherent risks associated with participating in sports and/or athletic training that cannot be eliminated. These risks include but are certainly not limited to: (1) minor injuries such as scratches, cuts, bruises and strains; and (2) major injuries such as injuries to the eyes, infection, loss of sight, joint injuries, back injuries, heart attacks, concussions, paralysis and even death. Also included in these risks are the same or similar injuries that might result from using training equipment, actual use of a field or training facilities, the acts of others or from the unavailability of emergency staff or emergency medical care (hereinafter we shall define all of these risks and potential injuries as “Risks”). All of these Risks will be present in the activities that you and/or your minor will be participating with PV INTERNATIONAL SPORTS KIDS LLC (the “Activities”).

INITIALS:

, on behalf of myself and/or my minor, ASSUME ALL OF THE RISKS THAT MAY OR CAN ARISE OUT OF PARTICIPATING IN THE ACTIVITIES, INCLUDING BUT NOT LIMITED TO THE ATHLETIC ACTIVITY ITSELF, USE OF THE EQUIPMENT, FIELD OR FACILITIES, THE ACTS OF OTHERS OR THE UNAVAILABLITY OF EMERGENCY CARE, as well as those Risks described in the preceding paragraph.

INITIALS:

I, on behalf of myself and/or my minor and/or our heirs, personal representatives and/or assigns, also agree to indemnify and hold PV INTERNATIONAL SPORTS KIDS LLC, its affiliates, subsidiaries, assigns, partners, attorneys, members, employees, independent contractors, shareholders, officers, directors, and agents or any producers, investors, or any other person or entity associated in any way with the ownership, operation or affiliation with recreational facilities and the creation, production or distribution of PV INTERNATIONAL SPORTS KIDS LLC-related marketing content on any PV INTERNATIONAL SPORTS KIDS LLC -owned website, harmless from any and all claims, causes of actions, lawsuits, arbitrations or proceedings as well as from any expenses, judgments, costs, fees, damages, expenses and/or liabilities, including attorneys’ fees incurred in defending or prosecuting any such claims brought against PV INTERNATIONAL SPORTS KIDS LLC as the result of my or my minor’s participation in the Activities. I hereby allow PV INTERNATIONAL SPORTS KIDS LLC to use my or my minor’s image or likeness without current or future compensation for marketing purposes related to PV INTERNATIONAL SPORTS KIDS LLC.

INITIALS:

I, on behalf of myself and/or my minor and/or our heirs, personal representatives and assigns, in consideration for being permitted to participate in the Activities HEREBY RELEASE, WAIVE AND DISCHARGE PV INTERNATIONAL SPORTS KIDS LLC from any and all liability associated with or related to my or my minor’s participation in the Activities and agree NOT TO SUE PV INTERNATIONAL SPORTS KIDS LLC for any reason resulting from or associated with my or my minor’s participation in the Activities. This waiver and release is intended to include all claims for injuries, accidents, illnesses, or property loss, whether known or unknown or anticipated or unanticipated, which are in any way related to or associated with the Activities.

INITIALS:

I, on behalf of myself and/or my minor, acknowledge that

PV INTERNATIONAL SPORTS KIDS LLC

is not obligated and therefore may not to carry insurance on behalf of myself or my minor.

INITIALS:

I, on behalf or myself and/or my minor, understand and acknowledge that I/we are surrendering valuable legal rights in this agreement.

INITIALS:

I, on behalf or myself and/or my minor, understand and expressly agree that this agreement is intended to be as broad and inclusive as permitted by the law of the State of Florida for which it is used and that if any portion of this agreement is held invalid, it is agreed that the balance of the agreement shall continue in full force and effect and that whatever portion is held invalid shall be interpreted and construed to afford as much protection to PV INTERNATIONAL SPORTS KIDS LLC as permitted by the applicable law.

INITIALS:

I am the parent and/or legal guardian of the above-named minor participant. I HAVE READ AND HAVE an appreciation for and an UNDERSTANDING OF THESE RISKS, and affirm that the Player is a minor and his/her participation in these Activities is voluntary. I understand that I am surrendering legal rights on behalf of the minor and myself. I, on behalf of myself and my minor, agree to be bound by all the terms of this agreement and give my consent to allow the minor Player to participate in the Activities described herein. I release and agree to indemnify and hold harmless the Releasees from any kind and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from the negligence of the releases to the fullest extent permitted by law.

INITIALS:

I, on behalf of myself and/or my minor participant hereby grant PV INTERNATIONAL SPORTS KIDS LLC its legal representatives, agents, successors or assigns, permission to use my likeness in photographs, movie films, videotapes and/or sound records, or any part thereof in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of PV INTERNATIONAL SPORTS KIDS LLC and will not be returned. I further irrevocably authorize PV INTERNATIONAL SPORTS KIDS LLC to edit, alter, copy, exhibit, publish or distribute the photographs, movie films, videotapes and/or sound records, for purposes of publicizing programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.

Parent/Guardian’s Signature

Sign Here

Parent/Guardian’s Name

Relationship to Minor

Date