Text Box: HEALTH INFORMATION   Do you have any physical disorder or health condition (such as asthma, diabetes, heart problems, seizures or back, joint or muscle problems) or any condition that may affect your ability to row safely, or that your coach should know about?   Please check one:       yes ____            no ___   If yes, please explain:           WAIVER OF LIABILITY: (signature required)   I understand that my participation involves rowing in an open craft in a physically demanding activity where there may be unusual risks to my health and safety.  In addition, I understand that certain on-shore activities such as carrying boats, may pose unusual risks to my health and safety.  My decision to participate in this program is made by me in full recognition of these risks and is entirely voluntary.  I represent that I am in adequate physical condition to participate in these activities and that I will notify my coach if I have or if I develop any physical problem or health condition that may affect my ability to participate in these activities without posing a danger to my health or safety, or the health or safety of others.  In consideration of your acceptance of this application, I hereby agree for myself, my executors, administrators and assigns to hold harmless Cape Cod Rowing, Inc., its directors, officers, employees, representatives, successors, agents and assigns from all liability on account of any injury, loss, claim or damage to my health, well-being or property during my participation in this program.   Signature of Participant:_________________________________Date:_________________________ Parent or Guardian (if participant is under 18):     SWIM TEST CERTIFICATION: All rowers are required to show swimming competency.  A swim test certification establishes that the participant can swim 100 yards in a competent manner and can remain afloat for at least five minutes.  A certified life guard/water safety instructor can observe you and document the following information. If you cannot locate such a program, Cape Cod Rowing can administer such a swim test.

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C.C.R. Waiver-Liability Form

NAME OF PARTICIPANT:                                                                             DATE:

NAME OF OBSERVER AND TITLE:

NAME & ADDRESS OF POOL/BEACH:

SIGNATURE OF OBSERVER: