Community Recreation Program

Panama Central School Community Recreation Program

Last Name ______First Name ______

Home Phone ______Cell Number ______

______Street City State Zip Participants: Please use this form to list one or two people we could contact in case of an emergency during the times you may be in the school building. List first and last names and telephone numbers. Emergency Contact #1: ______Phone: ______Emergency Contact #2: ______Phone: ______

OPTIONAL - Medical condition you want supervisors to be aware of: ______

______Date Signature

Cancellations . . . is an information Cancellation meet. not will events a emergency, to or due holiday closed is school When PANAMA CENTRAL SCHOOL PANAMACENTRAL Website: nounced on: News Channel 7 WKBW 7 Channel Channel 2 WGRZ 2 Channel Television Stations: Television Channel 4 WIVB 4 Channel Phone: 716 Radio Stations: Radio KISS 106.9 FM 106.9 KISS Fax: 716 WJTN/WWSE Panama Panama NY 14767 WKSN/WHUG

41 North Street Radio 930 WBEN 930 Radio http Spectrum ://www.pancent.org

782 - 782 - 4674 - 2455

- - - TV

Panama Central Recreation Community Program School

SWIMMING POOL RULES § Listen to the lifeguards at all times, as they are the Recreation Program Because we CARE about your safety we ask final authority of the pool. The lifeguards reserve that you: the right to remove any person from the pool if Sept. 30, 2019-May 21, 2020 they act in an unsafe manner or dangerous § Walk at all times on the pool deck. Walking Times situation for themselves or others. § Shower before entering the pool. The management reserves the right to refuse Monday-Friday § Not dive in the shallow end. admittance to or eject from the pool premises, any 6:15 AM to 7:30 AM § Do not swim if you are a person with infectious person failing to comply with any of the above 3:30 PM to 9:00 PM or communicable disease. health and safety regulations. § Do not swim if you are a person with open Use of Pool blisters, cuts, burns, stitches, etc. INFORMED CONSENT AND ASSUMPTION OF Adult Lap Swim § Don't spit, spout water, blow nose or discharge RISK AGREEMENT

Monday-Friday bodily waste in pool. As a condition of using the Panama Central School’s

6:15 AM to 7:30 AM § Don't run, push, dunk, be boisterous or rough Fitness Facilities, all participants will agree to the play, or be noisy in pool area, showers, or following terms and conditions: dressing rooms. 1. I agree to follow all directions of the supervisor Adults and Families § Don't use common towels, combs, brushes, and and acknowledge that failure to follow such drinking cups. Monday & Wednesday directions may result in the termination of my § Don't bring food or drink on pool deck. 7 PM to 9 PM privilege to use the school’s facilities. § Supervise or accompany all children under the 2. I understand that the supervision provided by ALL CHILDREN MUST BE ACCOMPANIED fourth grade. the district is general in nature and the BY AN ADULT § Always enter the water forward without supervisor is not responsible for supervising or *Please be aware that the pool will be flipping. monitoring the manner or intensity of my use of closed the night of a home Panama § Use only plastic containers and toys in the pool the equipment or participation in exercise Varsity Swim Meet and shower areas. activities. I further agree to use all equipment § Use the pool ladders one at a time and only for in a way that is not injurious to my health and getting in and out of the water. physical condition. Party/Group Rental § Stay in the shallow end of the pool if you are a 3. I hereby acknowledge that my use of the Friday weak or a non-swimmer. district’s fitness facilities involves risks including possible injuries to bones, muscles, 7 PM to 9 PM § Use swim diapers not disposable diapers. § Wear proper attire in the swimming pool-- no tendons and ligaments, dehydration, abnormal Saturdays by Request cut-offs. blood pressure, fainting and heart disorders Pool Rental Fee Prepaid When Reserved (including heart attacks). Based on the § Don't scream or yell for unneeded help. District Residents $120/two-hour party foregoing, I assume all risks associated with my § Dive only in permitted areas as stated in use of the district’s fitness facilities and have Out of District $140/two-hour party Section 6-1.10(1 X 4) of the New York State consulted with my personal physician. Sanitary Code. (Exceptions will be granted by 4. I hereby release the Panama Central School Coach or Supervisor) Gym, Weight/Cardio Rooms District, its Board of Education, in both their Respect corporate and individual capacities, its Adults and Students Show RESPECT for others and our facility: employees and supervisors for all claims (of in Grades 9-12 Only § Chewing gum, eating and drinking in the pool any nature) relating to my use of the district’s area are prohibited. facilities including, but not limited to, claims for Mondays & Wednesdays personal injury or death and damage to or loss § Pushing, dunking, rough play and fighting are of personal items. 7 PM to 9 PM prohibited. *All Participants Must Sign in*