Swimming Pool Waiver and Release of Liability Form
Release of Liability, Waiver of Claims, Assumption of Risk, and Indemnity Agreement
PLEASE READ CAREFULLY. BY SIGNING THIS DOCUMENT, YOU CHOOSE TO WAIVE CERTAIN LEGAL RIGHTS,
To: The Lake Powell Peace House (Owner of Property, Releasees)
I wish to swim at the Center’s pool facilities during the length of stay at your vacation home. By swimming in
•
At no time is there a lifeguard on duty, you (the renter) are responsible for the safe operation of the pool and are responsible
for all pers
ons using the po
ol during your sta
y.
• My use of the pool facilities during my stay involves certain risks, including but not limited to:
1. The risk of injury resulting from possible malfunction of the pool equipment;
2. The risk of injuries resulting from tripping or falling over obstacles in the pool area;
3. The risk of injuries resulting from unsupervised divers and swimmers colliding;
4. The risk of other injuries resulting from participating in any action in the pool.
• I recognize and fully understand that the above list is not a complete or exhaustive list of all possible
risks;
the list only provides
examples of types
of risks t
hat I am assu
ming.
In exchange for the Owner allowing me to utilize the pool and area during my stay, I hereby agree to the
conditions below. I fully intend and choose to give up the legal rights, as stated below:
1. TO WAIVE ANY AND ALL CLAIMS that I have or may have in the future against the Owner, its directors,
officers, employees, agents, or representatives (hereinafter referred to as the “Releasees”) relating to
2. TO RELEASE THE RELEASEES from any and all liability for any loss, damage, injury, expense, or other
cost that I may suffer or that my next of kin may suffer in connection with my use of the Releasees
pool or pool area to any cause whatsoever, INCLUDING NEGLIGENCE ON THE PART OF THE RELEASEES;
3. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability to property, or personal
injury to,
any third party, resulting
from the use of th
e pool or p
ool area
4. That I am over the age of 18 and that I am responsible and will adhere to all the rules of the property;
5. That this Waiver, Release, and Agreement is fully effective and shall be effective and binding upon me,
and my heirs, next
of kin, execut
ors, administrators
, and assign
s, or anyone else
authorized to a
ct on
I have read and understood this document. I am aware that by signing this document, I am waiving certain
Signed: _____________________________ Print:_________________________ Date: ____________
Date of Birth: _______________________