Adult Swim Registration

Swimmer Information

Swimmer's Name: *

Swimmer's Email: *

Swimmer's Phone: *

Emergency Contact

Emergency Contact's Name: *

Emergency Contact's Phone: *

I understand that unsupervised adult swim is only permitted between the hours of 6:00 am and 9:00 am (8:00 am during the swim team season May 11 – July 18) and that I must abide by the "buddy system" and have another adult present when I am swimming. No children under the age of 18 are allowed.


I hereby acknowledge having received and read the attached Rules and Regulations pertaining to swimming at Southern Village Club, including but not limited to those pertaining to adult swimming during times when the pool is not staffed by lifeguards. By execution of this Waiver, Release and Acknowledgement, I agree to abide by those rules and all other reasonable safety measures and agree and acknowledge that failure to do so would be negligence on my part. I hereby assume all risks and hazards incidental to swimming and related activities at Southern Village Club and transportation to and from the activities, regardless of whether I am in compliance with the rules, otherwise negligent, or not. I UNDERTAKE TO SWIM WITHOUT LIFEGUARD OR OTHER STAFF AT MY OWN RISK. I release and absolve and indemnify, Southern Village Club, LLC, it owners, agents, employees, volunteers and sponsors from all liability associated with the activity and in the event of injury, do expressly waive all claims against them.

I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

 By checking this box and typing my name below, I am electronically signing my application.

Member Signature (Type your name): *

* Required Information