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Primary Adult Guest Name
Household Address

All additional over 18's MUST complete their own form.

Guest minor 1 under 18 years of age.
Guest minor 2 under 18 years of age.
Guest minor 3 under 18 years of age.
Guest minor 4 under 18 years of age.
There is no lifeguard on duty at the pool.
I assume full responsibility for my children while using the pool
I fully intend to waive any and all claims that I have or may have in the future against GYANSAV LLC,The Grand Lake Club, its directors, officers, employees, agents, representatives, other participants, sponsoring agencies or contractors (hereinafter referred to as the “Releasees”) relating to my use of the pool and pool area
I fully intend 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
I willingly agree to comply with the stated and customary rules, terms and conditions for use and participation, as stated herein and as posted at the swimming pool. Should there exist any discrepancy or conflict between the rules posted at the swimming pool and the terms of this agreement, this agreement shall control. If 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 nearest official immediately
I fully intend TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from all liability to property, or personal injury to, any third party, resulting from the use of the pool or pool area
That I am over the age of 18 and that I am responsible and will adhere to all the rules of the property
If I am signing on behalf of any covered minors, I hereby represent that I full legal authority to act on their behalf and to bind them to the terms of this document. I understand that I must accompany any covered minors to the pool and remain with them at all times
I understand that this Waiver, Release, and Agreement is fully effective and shall be effective and binding upon me, and my heirs, next of kin, executors, administrators, and assigns, or anyone else authorized to act on my behalf or on behalf of my estate. I have read and understood this document. I am aware that by signing this document, I am waiving certain legal rights that I may have against the Releasees, and I fully agree to do so
I agree to adhere to the pool rules found at at the link below or risk a warning, suspension or expulsion from the property
Clear Signature
signed on behalf of all those listed in this waiver