ASA 2019 Waiver With Fees
I hereby verify that the information above is correct, and in consideration of the above named swimmer(s) being allowed to participate in any way in the Atlanta Swim Association, related events and activities (the ASA Programs"), the undersigned acknowledges, appreciates and agrees that: 1. The risk of injury from the activities involved in the ASA Programs is significant, including the potential for permanent disability and even death, and while particular rules, equipment and personal discipline may reduce the risk, the risk of serious injury to the Swimmer does exist; and 2. On behalf of Swimmer, myself and spouse, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF RELEASEES or others, and assume full responsibility for the participation of Swimmer in the ASA Programs; and 3. On behalf of Swimmer, I willingly agree to comply with the states and customary terms and conditions for participation in the ASA Programs. If I observe any unusual significant concern in the readiness of Swimmer for participation or in the ASA Programs, I will remove Swimmer from participation and bring such to the attention of the nearest official immediately, and 4. On behalf of Swimmer, myself, my spouse and our heirs, personal representatives and next of kin, I HEREBY RELEASE THE ATLANTA SWIM ASSOCIATION and CAPITAL CITY SPORTS, INC , its directors, officers, agents and/or employees, other participants, sponsoring agencies, facility owners and lessor, sponsors and advertisers (the "Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to Swimmer's involvement or participation in the ASA Programs, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 5. On behalf of Swimmer, myself, my spouse and our heirs, personal representatives and next of kin, I HEREBY INDEMNIFY AND HOLD HARMLESS ALL THE ABOVE Releasees from any and all liabilities incident to Swimmer's involvement or participation in the ASA Programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS AND HAVE HAD ALL MY QUESTIONS FULLY ANSWERED, FULLY UNDERSTAND THAT I HAVE THE CHOICE OF NOT PARTICIPATING IN THE ASA PROGRAMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
ASA Concussion Statement
Parent/Athlete Concussion Information Sheet A concussion is
a type of traumatic brain injury that changes the way the brain normally works.
A concussion is caused by bump, blow, or jolt to the head or body that causes
the head and brain to move rapidly back and forth. Even a “ding,” “getting your
bell rung,” or what seems to be a mild bump or blow to the head can be serious.
WHAT ARE THE SIGNS
AND SYMPTOMS OF CONCUSSION?
Signs and symptoms of concussion can show up right after the
injury or may not appear or be noticed until days or weeks after the injury. If
an athlete reports one or more symptoms of concussion listed below after a
bump, blow, or jolt to the head or body, s/he should be kept out of play the
day of the injury and until a health care professional, experienced in
evaluating for concussion, says s/he is symptom-free and it’s OK to return to
Did You Know?
Most concussions occur without loss of
consciousness. Athletes who have, at any point in their lives,
had a concussion have an increased risk for another concussion. Children and teens are more likely to get a
concussion and take longer to recover than adults. SIGNS OBSERVED BY
COACHING STAFF SYMPTOMS REPORTED BY ATHLETES Appears dazed or stunned Headache or “pressure” in head Is confused about
assignment or position Nausea or vomiting Forgets an instruction Balance problems or
dizziness Is unsure of game, score, or opponent Double or blurry vision Moves clumsily Sensitivity to light Answers questions slowly Sensitivity to noise Loses consciousness (even briefly) Feeling sluggish, hazy, foggy, or groggy Shows mood, behavior, or personality changes Concentration or memory problems Can’t recall events prior to hit or fall Confusion Can’t recall events after hit or fall Just not
“feeling right” or “feeling down” CONCUSSION DANGER
In rare cases, a dangerous blood clot may form on the brain
in a person with a concussion and crowd the brain against the skull. An athlete
should receive immediate medical attention if after a bump, blow, or jolt to
the head or body s/he exhibits any of the following danger signs:
One pupil larger than the other Is drowsy or cannot be awakened A headache that not only does not diminish, but
gets worse Weakness, numbness, or decreased coordination •
Repeated vomiting or nausea Slurred speech Convulsions or seizures Cannot recognize people or places Becomes increasingly confused, restless, or
agitated Has unusual behavior Loses consciousness (even a brief loss of
consciousness should be taken seriously) WHY SHOULD AN ATHLETE
REPORT THEIR SYMPTOMS?
If an athlete has a concussion, his/her brain needs time to
heal. While an athlete’s brain is still healing, s/he is much more likely to
have another concussion. Repeat concussions can increase the time it takes to
recover. In rare cases, repeat concussions in young athletes can result in
brain swelling or permanent damage to their brain. They can even be fatal.
WHAT SHOULD YOU DO IF YOU THINK YOUR ATHLETE HAS A
If you suspect that an athlete has a concussion, remove the
athlete from play and seek medical attention. Do not try to judge the severity
of the injury yourself. Keep the athlete out of play the day of the injury and
until a health care professional, experienced in evaluating for concussion,
says s/he is symptom-free and it’s OK to return to play. Rest is key to helping
an athlete recover from a concussion. Exercising or activities that involve a
lot of concentration, such as studying, working on the computer, or playing
video games, may cause concussion symptoms to reappear or get worse. After a
concussion, returning to sports and school is a gradual process that should be
carefully managed and monitored by a health care professional. Remember
Concussions affect people differently. While most athletes with a concussion
recover quickly and fully, some will have symptoms that last for days, or even
weeks. A more serious concussion can last for months or longer. It’s better to
miss one game than the whole season.
For more information on concussions, visit:
I HAVE READ THIS WAIVER AND I AGREE TO ITS TERMS.
Enter your initials to indicate acceptance: