Fillable Dayton SPRING 2019 LIFEGUARD PRESKILL REGISTRATION FORM

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Dayton SPRING 2019 LIFEGUARD PRESKILL REGISTRATION FORM

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PRESKILLS 1 | $15
SUNDAY, JANUARY 27 | NOON–1:00PM
PRESKILLS 2 | $15
SUNDAY, FEBRUARY 10 | NOON–1:00PM
PRESKILLS 3 | $15
SUNDAY, FEBRUARY 17 | NOON–1:00PM
PRESKILLS 4 | $15
SUNDAY, MARCH 3 | NOON–1:00PM
PRESKILLS 5 | $15
SUNDAY, MARCH 31 | NOON–1:00PM
PRESKILLS 6 | $15
SUNDAY, APRIL 7 | NOON–1:00PM
PRESKILL COURSE SELECTION
*Registration for each course ends when a course reaches max capacity
(20 participants) or at the registration deadline, whichever comes rst.
SPRING 2019 LIFEGUARD PRESKILL REGISTRATION FORM
PROCESSED BY: DATE:
This registration form and payment must be submitted to UDCR concurrently. Payment must be made in full at the time of registration to ensure
space in the course. Each participant must be enrolled by the registration deadline for each PreSkill oering. Form(s) can be submitted in-person at
the RecPlex, or via mail, fax or email. For more information regarding Preskill and Lifeguard courses, visit our website at go.udayton.edu/campusrec.
MINORS PAPERWORK — Is collected through a system called CampDoc. Further instruction will be sent out via email upon completion of registration.
PARTICIPANT AGE — Particpants must be at least 15 years of age prior to the nal day of the lifeguarding course they choose to enroll in.
LIFEGUARD COURSE REGISTRATION — Participants intending to take a Lifeguarding course through UDCR must rst pass one of the below Preskills
courses. Upon successful completion of the Preskills, participants will be able to register for a course at the RecPlex Welcome Desk. Registration forms
for the course will be provided at that time.
PROPER SWIM ATTIRE — Please ensure that you bring a swimsuit, towel and goggles (preferred, but not required) the day of the course.
COURSE LOCATION — All courses will take place within the Aquatic Center at the University of Dayton RecPlex: 2 Evanston Ave. Dayton, OH 45409.
PARKING — Free, open parking is available on weekends in the “visitors” C Lot o of Evanston Avenue.
INFORMATION FOR REGISTRATION AND PAYMENT
PARTICIPANT INFORMATION
FIRST NAME LAST NAME PHONE EMAIL
FIRST NAME LAST NAME NICKNAME
DATE OF BIRTH AGE GENDER MALE FEMALE
STREET ADDRESS CITY STATE ZIP
HAS PARTICIPANT TAKEN A UDCR CERTIFICATION BEFORE? YES NO IF YES, LIST YEARS ATTENDED:
HOW DID YOU HEAR ABOUT US? (CHECK ALL THAT APPLY): WEB EMAIL REFERRED BY: OTHER:
Registration Deadline: // Registration Deadline: //
TOTAL OF THIS FORM:
(To be paid at time of registration)
Registration Deadline: // Registration Deadline: //
Registration Deadline: // Registration Deadline: //
CAMPUS RECREATION | PARTICIPANT AGREEMENT
I recognize and acknowledge that use of UD Campus Recreation facilities, equipment, and programs
entails certain inherent risks that could result in physical or emotional injury. I voluntarily and freely
assume all risk of accident, injury, illness, or damage to or loss of property which I may sustain as a
result of participating in any and all activities associated with UD Campus Recreation.
I hereby declare that I am in good health and have no mental or physical condition or symptoms
that could interfere with my safety or the safety of others while participating in any activity using
any equipment or facilities of UD Campus Recreation. Furthermore, I certify that I have adequate
health insurance to cover any injury or damage that I may suer while participating, or alternatively,
agree to bear all costs associated with any such injury or damages to myself.
I the undersigned do hereby release, hold harmless, indemnify, waive and discharge the University
of Dayton and all its ocers, agents, and employees from and against any and all claims, demands,
actions or causes of action arising from any injuries or damages I may suer or sustain from my
participation in, or use of, any facility, equipment, and/or programs. Furthermore, in full recognition
and appreciation of the potential dangers and hazards inherent in athletic and other activities, I do
hereby agree to assume any and all risks, liabilities, and responsibilities for all accidents, injuries,
damages, or property losses arising from my participation.
In the event of a medical emergency requiring more than basic rst aid, I authorize University of
Dayton ocials and Board of Trustees of University of Dayton to secure from any licensed hospital,
physician, and/or medical personnel any treatment deemed necessary for my immediate care and
agree that I will be responsible for payment of any and all medical services rendered.
I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS.
PRINT NAME OF PARTICIPANT PRINT NAME OF PARENT/LEGAL GUARDIAN (IF UNDER 18)
SIGNATURE OF PARTICIPANT SIGNATURE OF PARENT/LEGAL GUARDIAN (IF UNDER 18)
DATE DATE
UPDATED NOVEMBER 2018
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Dayton SPRING 2019 LIFEGUARD PRESKILL REGISTRATION FORM

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Completed 25 March 2020

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