Red Cross Lifeguard and WSI Certification

PARTICIPANT FULL NAME*

First Name Last Name

COMPANY NAME

PARTICIPANT ADDRESS*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

PARTICIPANT EMAIL | Confirmation Email will be sent to the email address entered*

Email Confirm Email

PARTICIPANT CELL PHONE*

PARTICIPANT DATE OF BIRTH*

PARTICIPANT AGE*

MEDICAL CONDITION / MEDICATION

EMERGENCY CONTACT NAME*

First Last

EMERGENCY CONTACT RELATIONSHIP*

EMERGENCY CONTACT PHONE NUMBER*

COURSE NAME*

Lifeguard Training
Lifeguard Recertification
Lifeguard Instructor
Lifeguard Instructor/IT Review
Water Safety Instructor

CLASS DATE*

CLASS LOCATION*

Onsite Group Training
Veterans Memorial AQ Center | 5310 E 136th Ave, Thornton, CO

REFUND AND CLASS TRANSFER POLICY

REFUND POLICY

There are no refunds once the course fee has been received. Includes: participants who do not successfully complete the course or course prerequisites, do not attend all scheduled class dates and times, do not pass course skills with proficiency (according to American Red Cross requirements) or do not pass the written exam with a score of at least 80 percent.

CLASS TRANSFER | Class Transfer Fee is $45.00

The class transfer fee is $45.00 and must be received to transfer class dates. Participants must submit the Class Transfer & Wavier Release Forms online at least 72 hours prior to the original class date. Participants may transfer a total of one time and training must be completed within 90 days of the original class date. Please choose a class date and location you will be able to attend.

CANCELLED CLASS

Streamline Health Services reserves the right to cancel any class. If a class is cancelled, registered participants will be given the option to transfer to another class date or receive a full refund.

CHECK BOX*

I have READ, UNDERSTAND and ACKNOWLEDGE Streamline Health Services, LLC Refund and Class Transfer Policy. Furthermore, I have READ, UNDERSTAND and ACKNOWLEDGE NO REFUNDS will be issued once course fees have been received.

AMERICAN RED CROSS COURSE PREREQUISITES AND COMPLETION REQUIREMENT

American Red Cross requires participants to successfully complete course prerequisites and course completion requirements, to receive certification. Refunds will not be issued to participants who do not successfully complete all course prerequisites and course completion requirements, according to the American Red Cross standards. Please make sure you can complete the course prerequisites and course completion requirements before you attend class. Thank You!

Check Box*

I have READ, UNDERSTAND and ACKNOWLEDGE NO REFUNDS will be issued to participants who do not successfully complete the American Red Cross course prerequisites and course completion requirements.

Participant Signature*

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Date of Signature*

Parent/Guardian Signature (if participant is under the age of 18 years old)*

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Date of Signature*

Streamline Health Services, LLC
Course Participant Waiver/Release Form (“Agreement”)

IN CONSIDERATION of being permitted to participate in any way in the activity: LIFEGUARDING, WATER SAFETY, FIRST AID, CPR AND/OR AED COURSES ("Activity") I, for myself, my personal representatives, assigns, heirs, and next of kin:

1. ACKNOWLEDGE, agree, and represent that I understand the nature of the Activity, that I voluntarily wish to participate and that I am qualified, in GOOD HEALTH, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.

2. FULLY UNDERSTAND that: (a) CLASS PARTICIPATION, ESPECIALLY ACTIVITIES INVOLVING SKILL PRACTICE AND TESTING (ESPECIALLY IN-WATER PRACTICE AND TESTING), HAVE DAMAGES, RISKS OF ILLNESS, INJURY INCLUDING SERIOUS BODILY INJURY OR DEATH (Risks); (b) TRAVELING TO AND FROM CLASS at the start, end, or break of class, OR TRAVELING TO SEPARATE TRAINING SITES, if two or more training sites are utilized, may involve driving, ride sharing, or otherwise traversing public streets, THEREBY INCURRING ADDITIONAL RISK OF INJURY INCLUDING SERIOUS BODILY INJURY OR DEATH (Risks); (c) these Risks may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (d) 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 RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity.

3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE Cathedral Catholic High School, Southlake Aquatics Complex/Carroll ISD, Bruce Eubanks Natatorium/Frisco ISD, City of Huntington Beach, Country Club of Colorado, Lilley Gulch Recreation Center/Ridge Recreation Complex/Foothill Recreation District, Watersafe Swim School, Veterans Memorial Aquatics Complex/City of Thornton/Thornton ISD, Streamline Health Services, Amy Alexander, their facilities/instructors/coaches/leaders conducting the Activity as well as their agents, employees, third party contact instructors, guest speakers, or assistants; the certifying agency if course certificates are being issued; other course participants; and, if applicable, the owners and lessors of premises on which the Activity takes place (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, NEGLIGENT SECURITY, AND RECREATIONAL OPERATIONS AND ACTIVITIES; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releases, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.

4. CONSENT, AUTHORIZATION, AND RELEASE OF PICTURES AND VOICE: the undersigned UNDERSTANDS AND ACKNOWLEDGES that during my participation with Streamline Health Services, pictures, including video and still pictures may be taken of the undersigned and with sound of undersign's voice and may subsequently be used for promotion, marketing and social media purposes. I AUTHORIZE the use of my name and pictures including any accompanying voice to be exhibited with or without advertising pictures, television, video, social or similar media and HEREBY RELEASE STREAMLINE HEALTH SERVICES, AMY ALEXANDER AND THEIR INSTRUCTORS, ASSISTANTS, EMPLOYEES AND AGENTS FROM ANY AND ALL CLAIMS FOR THE TAKING AND USE OF THE SAME.

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 ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT 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.

Participant Signature*

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Date of Signature*

MINOR’S RELEASE – ONLY IF PARTICIPANT IS UNDER THE AGE OF 18 YEARS

AND I, THE MINOR'S PARENT AND\OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF AFOREMENTIONED ACTIVITY AND THE MINOR'S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE'S FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR'S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, AND FURTHER AGREE THAT, DESPITE THIS RELEASE, IF I, THE MINOR, OR ANYONE ON THE MINOR'S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.

Name of Parent/Guardian*

First Last

Parent/Guardian Phone Number*

Parent/Guardian Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent / Guardian Signature*

Use your mouse or finger to draw your signature above

Date of Signature*

CAPTCHA

LIFE. PROTECTED.

STREAMLINE HEALTH SERVICES, LLC WAIVER/RELEASE FORM

REFUND AND CLASS TRANSFER POLICY

AMERICAN RED CROSS COURSE PREREQUISITES AND COMPLETION REQUIREMENT

Streamline Health Services, LLC
Course Participant Waiver/Release Form (“Agreement”)

MINOR’S RELEASE – ONLY IF PARTICIPANT IS UNDER THE AGE OF 18 YEARS

LIFE. PROTECTED.

STREAMLINE HEALTH SERVICES, LLC WAIVER/RELEASE FORM

REFUND AND CLASS TRANSFER POLICY

AMERICAN RED CROSS COURSE PREREQUISITES AND COMPLETION REQUIREMENT

Streamline Health Services, LLC Course Participant Waiver/Release Form (“Agreement”)

MINOR’S RELEASE – ONLY IF PARTICIPANT IS UNDER THE AGE OF 18 YEARS

Streamline Health Services, LLC
Course Participant Waiver/Release Form (“Agreement”)