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LIABILITY RELEASE AND INDEMNIFICATION FORM FOR MINOR TRAVEL
I, the undersigned participant and parent, request voluntary participation for minor to travel to and
from USA Swimming events for the dates from
, 20 through ,20__.
I consent to my/minor’s participation in traveling to and from USA Swimming events and acknowledge
that the I fully understand my/minor’s participation in travel may involve risk of serious injury or
death, including losses which may result not only from my/minor’s own actions, inactions or
negligence, but also from the actions, inactions, or negligence of others. This includes all travel to and
from the event arranged by USA Swimming, including but not limited to all transportation being plane,
boat, train, van, car, airline and/or chartered plane paid either by the participant or travel paid or
reimbursed by USA Swimming. I understand that if I have any risk concerns regarding travel, I
should discuss the risks associated with my/minor’s participation with the activity coordinators and
event staff, before I sign this document and before travel begins.
Release – Minor’s Rights:
In consideration of allowing Minor Participant to travel to and from USA Swimming events, I hereby
release and hold harmless USA Swimming, members of its board of directors, and its officers,
employees, members, volunteers, other participants, and agents (collectively, the “Released Parties”),
of and from, and do discharge and waive, any and all claims, demands, losses, damages, and
liabilities that Minor Participant may have or sustain with respect to any and all damage and/or injury,
of any type, arising out of his or her travel to USA Swimming events. I also agree that if any portion
of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and
effect.
(Print name of minor) (Signature of minor) (Date)
Release – Parents’/Guardians’ Rights:
In consideration of allowing Minor Participant to travel to and from USA Swimming events, I hereby
release and hold harmless the Released Parties, of and from, and do discharge and waive, any and all
claims, demands, losses, damages, and liabilities that I may have or sustain with respect to any and
all damage and/or injury, of any type, arising from Minor Participant’s travel to and from USA
Swimming events. I also agree that if any portion of this agreement is held to be invalid the balance,
notwithstanding, shall continue in full force and effect.
I certify that my/minor is in good health and have no physical condition that would prevent traveling
to and from any USA Swimming events. Furthermore, I agree to use my/minor’s personal medical
insurance as a primary medical coverage payment if accident or injury occurs. I consent to
emergency medical treatment in the event such care is required.
(Print name of Parent/Guardian) (Signature of parent/guardian (Date)
Indemnification by Parent/Guardian:
The undersigned parent/guardian further agrees to indemnify, save and hold harmless the Released
Parties from any and all claims, demands, losses, damages and liabilities for indemnities, contribution
or otherwise with respect to any damage and/or injury, of any type, arising from Minor Participant’s
travel to and from USA Swimming events.
(Print name of Parent/Guardian) (Signature of parent/guardian) (Date)