Swim and Dive Team

CONCUSSION AWARENESS WAIVER -- READ BEFORE SIGNING

As may be required by state law, Brookside Swim Club is providing a concussion and head injury information sheet. The Concussion Information Sheet (three pages) is attached to this waiver. I acknowledge that the information contained in the Concussion Information Sheet is not medical advice and is no substitute for medical advice.
I acknowledge that I have received the Concussion Information Sheet. I also acknowledge that if I have any questions regarding the signs or symptoms of a concussion or other head injuries, the need to seek medical attention and the protocol for returning to daily activities, school, and the swimming pool, I will consult with a licensed health care provider

(If Applicant is under Age of Majority in his/her home state, the Parent(s) or Guardian(s) must execute the following Waiver in addition to the above)

Team Name: Brookside Dolphins

This is to certify on this date that I, as parent/guardian of ____________________________, participating in this competition, give my consent to Brookside Swim Club and its medical representatives to obtain medical care from any licensed physician, hospital, or clinic for the above mentioned athlete for injury that could arise from activities in this competition.

Parent’s/Guardian’s Name (Please Print): __________________________ Relationship: ___________________
Parent’s/Guardian’s Signature: __________________________________ Date: ___________________

CONCUSSION INFORMATION SHEET


Dear Parent/Guardian and Athletes,

This information sheet is provided to assist you and your child in recognizing the signs and symptoms of a concussion. Every athlete is different and responds to a brain injury differently, so seek medical attention if you suspect your child has a concussion. Once a concussion occurs, it is very important your athlete return to normal activities slowly, so he/she does not do more damage to his/her brain.

What is a Concussion?
A concussion is an injury to the brain that may be caused by a blow, bump, or jolt to the head. Concussions may also happen after a fall or hit that jars the brain. A blow elsewhere on the body can cause a concussion even if an athlete does not hit his/her head directly. Concussions can range from mild to severe.

Signs and Symptoms of a Concussion
Athletes do not have to be “knocked out” to have a concussion. In fact, less than 1 out of 10 concussions result in loss of consciousness. Concussion symptoms can develop right away or up to 48 hours after the injury. Ignoring any signs or symptoms of a concussion puts your child’s health at risk!

Signs Observed by Coaches, Officials, Parents or Guardians
Appears dazed, stunned or confused
Unsure about event, location of name of meet
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows behavior or personality changes – irritability, sadness, nervousness, emotional
Can’t recall events before or after incident

Symptoms Reported by Athlete
Any headache or “pressure” in head - how badly it hurts does not matter
Nausea or vomiting
Balance problems or dizziness
Double or blurry vision
Sensitivity to light and/or noise
Feeling sluggish, hazy, foggy or groggy
Concentration or memory problems
Confusion
Does not “feel right”
Trouble falling asleep
Sleeping more or less than usual

Be Honest
Encourage your athlete to be honest with you, his/her coach and your health care provider about his/her symptoms. Many young athletes get caught up in the moment and/or feel pressured to return to sports before they are ready. It is better to miss practice or meets than the entire season… or risk permanent damage!
Seek Medical Attention Right Away
Seeking medical attention on the day of the event is an important first step if you suspect or are told your swimmer has a concussion. A qualified health care professional will be able to determine how serious the concussion is and when it is safe for your child to return to sports and other daily activities:

No athlete should return to activity on the same day he/she gets a concussion
No athlete may return to training, regardless of sport, until he/she is cleared by a heath care professional with a note specifying clearance. Athletes should NEVER return to the pool if they still have ANY symptoms and in the case an athlete returns with a note and then during the practice complains of a headache or other symptoms, they must halt all activities
Parents and coaches should never pressure any athlete to return to play

The Dangers of Returning Too Soon
Returning to the pool too early may cause Second Impact Syndrome (SIS) or Post-Concussion Syndrome (PCS). SIS occurs when a second blow to the head happens before an athlete has completely recovered from a concussion. This second impact causes the brain to swell, possibly resulting in brain damage, paralysis, and even death. PCS can occur after a second impact. PCS can result in permanent, long-term concussion symptoms. The risk of SIS and PCS is the reason why no athlete should be allowed to participate in any physical activity before they are cleared by a qualified health care professional.

Recovery
A concussion can affect school, work, and sports. Along with coaches and teachers, the school nurse, athletic trainer, employer, and other school administrators should be aware of the athlete’s injury and their roles in helping the child recover. During the recovery time after a concussion, physical and mental rest is required. A concussion upsets the way the brain normally works and causes it to work longer and harder to complete even simple tasks. Activities that require concentration and focus may make symptoms worse and cause the brain to heal slower. Studies show that children’s brains take several weeks to heal following a concussion.

Returning to Daily Activities
Be sure your child gets plenty of rest and enough sleep at night – no late nights. Keep the same bedtime weekdays and weekends.
Encourage daytime naps or rest breaks when your child feels tired or worn-out.
Limit your child’s activities that require a lot of thinking or concentration (including social activities, homework, video games, texting, computer, driving, job‐related activities, movies, parties). These activities can slow the brain’s recovery.
Limit your child’s physical activity, especially those activities where another injury or blow to the head may occur.
Have your qualified health care professional check your child’s symptoms at different times to help guide recovery.


Returning to School
Your athlete may need to initially return to school on a limited basis, for example for only halfdays, at first. This should be done under the supervision of a qualified health care professional.
Inform teacher(s), school counselor or administrator(s) about the injury and symptoms. School personnel should be instructed to watch for:
Increased problems paying attention.
Increased problems remembering or learning new information.
Longer time needed to complete tasks or assignments.
Greater irritability and decreased ability to cope with stress.
Symptoms worsen (headache, tiredness) when doing schoolwork.
Be sure your child takes multiple breaks during study time and watch for worsening of symptoms.
If your child is still having concussion symptoms, he/she may need extra help with school-related activities. As the symptoms decrease during recovery, the extra help can be removed gradually.
Returning to the Pool
Returning to the pool is specific for each person. As an example, California law requires written permission from a health care provider before an athlete can return to play. Follow instructions and guidance provided by a health care professional. It is important that you, your child and your child’s coach follow these instructions carefully.
Your child should NEVER be on deck, practice, or participate in competition if he/she still has ANY symptoms. (Be sure that your child does not have any symptoms at rest and while doing any physical activity and/or activities that require a lot of thinking or concentration).
Be sure that the athletic trainer, coach and physical education teacher are aware of your child’s injury and symptoms.
Your athlete should complete a step-by-step exercise-based progression, under the direction of a qualified healthcare professional.
Resources:
Centers for Disease Control and Prevention - www.cdc.gov/Concussion
Zurich Concussion Conference (2012) - Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. http://bjsm.bmj.com/content/47/5/250.full
ODH Violence and Injury Prevention Program - www.healthyohioprogram.org/concusion
National Federation of State High School Associations - www.nfhs.org – Index concussions and see “A parent’s guide to concussion in sports”.

RELEASE OF LIABILITY -- READ BEFORE SIGNING

In consideration of being allowed to participate in any way in the Brookside Swim Club program, its related events and activities, I, (name of participant)_________________________________ , the undersigned, acknowledge, appreciate, and agree that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and,

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Brookside Swim Club, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, ILLNESS from any and all infectious disease, or loss or damage to person or property or WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

x________________________________ _____________ ______________________________
PARTICIPANT'S SIGNATURE AGE DATE SIGNED

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any 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 RELEASEES, to the fullest extent permitted by law.

x____________________________ _______________________ ____________________________________
PARENT/GUARDIAN’S SIGNATURE EMERGENCY PHONE #: DATE SIGNED












COVID-19 WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
READ BEFORE SIGNING
In consideration for receiving permission to be on premises at Brookside Swim Club (hereinafter the Activity or Activities), I, on behalf of myself and any minor child/children for whom I have the capacity to contract, hereby acknowledge and agree to the following:
1. I understand the hazards of the novel coronavirus and its variants (COVID-19) and am familiar with the Centers for Disease Control and Prevention (CDC) guidelines regarding COVID-19. I acknowledge and understand that that the circumstances regarding COVID-19 are changing from day to day and that, accordingly, the CDC guidelines are regularly modified and updated, and I accept full responsibility for familiarizing myself with the most recent updates.

2. Notwithstanding the risks associated with COVID-19, which I readily acknowledge, I hereby willingly choose to participate in Activities.

3. I acknowledge and fully assume the risk of illness or death related to COVID-19 arising from my being on the premises and participating in the Activities and hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE (on behalf of myself and any minor children from whom I have the capacity to contract) Brookside Swim Club, their owners, officers, directors, agents, employees and assigns (the RELEASEES) from any liability related to COVID-19 which might occur as a result of my being on the premises and participating in the Activities.


4. I shall indemnify, defend and hold harmless the RELEASEES from and against any and all claims, demands, suits, judgments, losses or expenses of any nature whatsoever (including, without limitation, attorneys fees, costs and disbursements, whether of in-house or outside counsel and whether or not an action is brought, on appeal or otherwise), arising from or out of, or relating to, directly or indirectly, the infection of COVID-19 or any other illness or injury.


5. It is my express intent that this Waiver and Hold Harmless Agreement shall bind any assigns and representatives, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE the above-named RELEASEES. This Agreement and the provisions contained herein shall be construed, interpreted, and controlled according to the laws of the State of New Jersey.


I HEREBY KNOWINGLY AND VOLUNTARILY WAIVE ANY RIGHT TO A JURY TRIAL OF ANY DISPUTE ARISING IN CONNECTION WITH THIS AGREEMENT. I ACKNOWLEDGE THAT THIS WAIVER WAS EXPRESSLY NEGOTIATED AND IS A MATERIAL INDUCEMENT FOR THE PERMISSION GRANTED BY RELEASEES TO BE ON PREMISES AND PARTICIPATE IN THE ACTIVITIES.


IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing
COVID-19 Wavier of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Agreement for full, adequate and complete consideration fully intending to be bound by same.
IN WITNESS WHEREOF, I have signed this Waiver and Agreement under seal on this

x________________________________ ______________________________
PARTICIPANT'S SIGNATURE DATE SIGNED








MEDICAL RELEASE WAIVER -- READ BEFORE SIGNING

I certify that I am the parent or legal guardian for my child(ren) and hereby give my permission for any supervisor, coach or other team administrator associated with the Brookside Swim Club to SEEK AND GIVE APPROPRIATE MEDICAL ATTENTION for our child(ren) in the event of accident, injury, and/or illness. I will be RESPONSIBLE FOR ANY AND ALL COSTS ASSOCIATED WITH ANY NECESSARY MEDICAL ATTENTION AND/OR TREATMENT.

I hereby waive, release and forever discharge Brookside Swim Club and associated supervisor, coach or other team administrator from all RIGHTS AND CLAIMS FOR DAMAGES, INJURY, LOSS TO PERSON OR PROPERTY WHICH MAY BE SUSTAINED OR OCCUR during participation in Brookside Swim Club activities, WHETHER OR NOT DAMAGES OR LOSS IS DUE TO NEGLIGENCE. I hereby acknowledge that my child(ren) is (are) physically fit and capable of participation in all aquatic team activities.

x____________________________ _______________________ ____________________________________
PARENT/GUARDIAN’S SIGNATURE EMERGENCY PHONE #: DATE SIGNED









MEDIA RELEASE WAIVER -- READ BEFORE SIGNING

I hereby authorize Brookside Swim Club to PUBLISH THE PHOTOGRAPHS AND/OR VIDEO TAKEN OF ME AND/OR THE UNDERSIGNED MINOR CHILDREN for use in the Brookside Swim Club publications, social media platforms and website. I release Brookside Swim Club from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed above and that I have the authority to authorize Brookside Swim Club to use their photographs and/or video footage.


x________________________________ _____________ ______________________________
PARTICIPANT'S SIGNATURE AGE DATE SIGNED

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these publications and website as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

x____________________________ _______________________
PARENT/GUARDIAN’S SIGNATURE DATE SIGNED