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Athlete Personal Information
My FIRST choice for summer camp dates are:
My SECOND choice for summer camp dates are:
My THIRD choice for summer camp dates are:
Preferred Pronoun
Best way for PCR to contact you?
In the fall of 2021, my child will be entering the following grade:
My child has previously participated in one of PCR's rowing programs:
PCR's activities take place on and around water. Do you need swim lessons for your child?
My child is proficient in swimming, and can easily swim 50 yards (two lengths of the pool) without stopping and tread water for more than two minutes (without a life jacket).
I am uncertain of my child’s swimming proficiency.
I am interested in swim lessons for my child so that they can increase their swimming proficiency and safety while in/around water.
Transportation - How will your child get to and from PCR?
Parent/Guardian Information
Are you the emergency contact?
Relationship (select one):
Alternate Contact Relationship:
Confidential Demographic Information
Parent/Guardian Education Level (check all that apply):
Questions Yes No
Do you speak a language other than english in your home?
Athlete Medical History
Does your child have any medical conditions? (i.e. diabetes, asthma, seizure disorder, etc.)?
Does your child take any medications?
Does your child have any allergies?
Has your child suffered any injuries in the last 18 months?
Will any medical condition, medication, allergy, or injury affect your child while he/she is rowing, running, or swimming?
Does your family have any history of heart problems at a young age?
Is there anything else PCR should know about your child's health?
Does your child have medical insurance?
Photo Release and Liability Waiver

Photo Release: I give PCR my permission to use my child's photo in materials that promote PCR. This may include brochures, newsletters, the Internet, or other electronic media, magazines, or television.

I agree to the above

A full waiver will be sent out to you either as a hard copy or via DocuSign. This waiver serves as a point of reference for what you will be signing once your child has fully enrolled in the program. 

 

PARTICIPANT WAIVER
In consideration of PCR permitting my child to participate in PCR's activities and program, I, on behalf of myself and my child, hereby release, discharge, and agree to indemnify and hold harmless the City of Philadelphia (the "City"), Philadelphia City Rowing (PCR), and both the City's and PCR's officers, directors, employees, subcontractors, volunteers, and agents from any and all claims, liabilities, or causes of action arising out of (1) the student's participation in PCR's activities and programs, or (2) the student's use of PCR's rowing facility, equipment, or other premises where practices and competitions take place to the fullest extent permitted by applicable law. 

I hereby give my child permission to participate in any and all programs associated with PCR, including but not limited to, PCR's rowing and educational programs and field trips related thereto (collectively, “PCR Activities”). I understand that PCR activities may include one or more of the following: rowing on the Schuylkill River; indoor training at venues to be specified; competing in regattas in and out of Pennsylvania; swim lessons and comprehension testing; and other such activities, including tutoring and mentoring, as they related to the goals of PCR. I fully understand that rowing (also a PCR Activity), includes, but is not limited to, rowing on the water, training, and proximity to rowing equipment, including boats, oars, docks, and launches used in connection with rowing involves risks and dangers of serious bodily injury, including permanent disability, paralysis and death.

It is anticipated that PCR may utilize vans and/or cars to transport participants to practices, races, field trips, and other events. I hereby give my permission for my child to be transported either (i) with the entire team to these events in the vans and/or cars used by PCR for transportation to these events or (ii) in the event that vans and/or cars do not have capacity to transport all rowers, coaches, and other PCR officials and volunteers, in a bus or with one of PCR's employees, coaches, officials or other volunteers in a private automobile. 

ASSUMPTION OF RISK AND WAIVER OF LIABILITY RELATED TO PCR ACTIVITIES ROWING ACTIVITIES – READ CAREFULLY. DO NOT SIGN UNLESS YOU READ CAREFULLY.

I fully understand that PCR Activities include, but are not limited to, rowing on the water, training, and being present around rowing equipment, including boats, oars, docks, and launches used in connection with rowing, and transportation to and from rowing activities and involve risks and dangers of serious bodily injury, including permanent disability, paralysis and death (“RISKS”); (b) these risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others participating in PCR Activities, the condition in which the activity takes place, or the negligence of the Releasees named below; (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILTY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the PCR Activities.

I further attest that I have disclosed all vital and important health information (allergies, medications, and medical limitations on activities) which would be necessary for the proper care of my child. I give my permission to PCR to give consent on my behalf in the event of the need for emergency administration of medical treatment which PCR, in its sole discretion, believes to be necessary and appropriate, including, without limitation, treatment by training First Aid personnel, EMTs, First Responders, Paramedics and Emergency Room Physicians. I agree to pay and to assume responsibility for all medical expenses incurred in the treatment of my child. 

ASSUMPTION OF RISK AND WAIVER OF LIABILITY RELATING TO SWIMMING AND WATER-BASED ACTIVITIES – READ CAREFULLY. DO NOT SIGN UNLESS YOU READ CAREFULLY.

Proof of swimming proficiency is required by the Philadelphia Scholastic Rowing Association, the Schuylkill Navy of Philadelphia, USRowing, and PCR’s own internal policies. PCR Activities, including rowing and other activities that take place on or around water, and that there is a very real risk of boats capsizing and athletes ending up in the water. At a minimum, all students must be able to swim 50 yards and tread water for 2 minutes prior to being allowed on the water without a life vest. These policies are not designed to exclude participants but rather to ensure everyone’s safety in the event that there is an accident/emergency and athletes end up in the water. 

I understand that my child will be participating in a water sport on the Schuylkill River and that there is a very real risk of boats capsizing. 

Please check box and initial:

  • I attest that my child is proficient in swimming, and that my child can easily swim 50 yards (two lengths of the pool) without stopping and tread water for more than two minutes (without a life jacket).
  • I am uncertain of my child’s swimming proficiency. Please explain: 
  • I am interested in swim lessons for my child so that they can increase their swimming proficiency and safety while in/around water. 

Please check box and initial:

  • I give permission for my child to participate in PCR Activities, including rowing and other on-water activities, WITHOUT a life jacket. 
  • I give permission for my child to participate in PCR Activities, including rowing and other on-water activities, so long as my child IS WEARING A LIFE JACKET
  • I DO NOT give permission for my child to participate in rowing and other on-water activities. 

 

ASSUMPTION OF RISK AND WAIVER OF LIABILITY RELATING TO COVID-19 - READ CAREFULLY. DO NOT SIGN UNLESS YOU READ CAREFULLY.

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing, wearing of masks and have, in many locations, prohibited the congregation of groups of people. 

Philadelphia City Rowing (“PCR”) has put in place preventative measures to reduce the spread of COVID-19; however, PCR cannot guarantee that you or your child will not become infected with COVID-19. Further, attending PCR could increase your risk and your child’s risk of contracting COVID-19. 

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child and I may be exposed to or infected by COVID-19 by attending PCR and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at PCR may result from the actions, omissions, or negligence of myself and others, including, but not limited to, PCR and City of Philadelphia employees, volunteers, and program participants and their families. I further represent and warrant that I have reviewed the CDC’s guidance and protocols relating to COVID available at: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html.

WAIVER OF LIABILITY - – READ CAREFULLY. DO NOT SIGN UNLESS YOU READ CAREFULLY.

In consideration of PCR permitting my child to participate in PCR's Activities and programs, I, on behalf of myself and my child, hereby release, discharge, and agree to indemnify and hold harmless the City, PCR, and both the City's and PCR's officers, directors, employees, subcontractors, volunteers and agents from any and all claims, liabilities or causes of action arising out of such treatment and with respect to the exercise of it and their judgment in this regard to the fullest extent permitted under applicable law.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child may experience or incur in connection with my child’s attendance at the PCR or participation in PCR’s programming (“Claims”). On my behalf, and on behalf of my child, I hereby release, covenant not to sue, discharge, and hold harmless PCR and the City of Philadelphia, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence PCR and the City of Philadelphia, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any PCR program.

IMPORTANT: I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without inducements or assurance of any nature, and intend to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

I agree to the above
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