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Adult Medical Release

Registration and Medical Release

Date of Birth
Month
Day
Year

Please check if the swimmer has any of the following:

Aquatic History

Has or vacations near

Aquatically skilled?
Yes
No
Has swimmer ever had an aquatic accident/incident?
Yes
No

Waiver Release Form for Liability/Medical Treatment

The participant and family of participants hold Terry Brown/Coastal Current Aquatics/City, any property owners/lessors harmless of any and all liability. I fully understand and release the aforementioned entities of any liability. I hereby authorize any medical treatment,  which may be advised during lessons.

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Disclaimers

  • The services provided are not Physical Therapy. Although I am a physical therapist, these services are offered solely for general wellness, education, and guidance.

  • There are no refunds unless there is a pool issue.

  • All personal and health-related information shared in this context is treated as confidential and will not be disclosed except as required by law.

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