fil/tools/benchmark-harness/vendored/docling/md/nougat_007.md

2021

CHILD CONSENT FORM

The privilege of letting member children at the age of 10 be dropped off so that they can enjoy the club unaccompanied by a parent or guardian is a longstanding tradition at the LRRC. In order for us to continue providing this privilege, we ask that the children adhere to the following rules. Please review this information with them and return the signed form to the club before you intend to drop off your child. Thank you for your understanding and support.

RULES/spaceliningAND/spaceliningREGULATIONS

Children ages 10 - 14

• Must have a 2021 Child Consent Form at the Front Desk
• Must have paid the 2021 Child Consent fee of $75 per child.
• Must check in at the Front Desk.
• Must have a current photograph in our computer system.
• May only be at the club unaccompanied by parents at the following times:
• Summer: 10:00 am - 8:00 pm
• School year: 10:00 am - 6:00 pm
• Must wear a wristband at check-in for their entire club stay. Club wristbands are non-transferrable.
• Are allowed in the recreational pool (when a life guard is on duty), basketball court and outside picnic areas.
• When using the poolside snack bar you must:
• Behave appropriately.
• Treat staff with respect.
• Vacate table when finished eating - no loitering.
• Are not allowed in the fitness rooms, indoor tennis center, 50-meter pool or LOCKER ROOMS without adult supervision. Two bathrooms, two showers and the changing room located on the 25 yard pool deck are available for their use.
• Are not allowed to play around the tennis courts or indoor tennis center.

Children ages 12 - 14

• May serve as hosts to guests who are at least 12 years old. Child hosts may only bring up to two guests at one time. Guests 12 to 14 years of age must have a Guest Child Form on file at the club in order to gain entry when unaccompanied by an adult member. (An individual guest may only visit the LRRC twice per week when unaccompanied by a parent/guardian host, regardless of different hosting members. The club week runs Monday-Sunday.) All guests between the ages of 12 and 14 are required to wear club issued wristbands during their entire stay. Guests must be accompanied by their hosts at all times while on club premises.

Unsafe or inappropriate behavior may result in suspension from using the club for the remainder of the day, the week or possibly the summer.

PARTICIPANT'S/spaceliningINFORMATION

Name: _______________________________________________________________________________________________________________ Date of birth: ____________________________ Gender: Male Female

Child's cell number (if applicable): : _______________________________________________________________________________________________________________________________________________________________________

Mother's name: _______________________________________________________________________________________ Father's name: ______________________________________________________________________________________

Street address: _______________________________________________________________________________________ City: ___________________________________________________ State: ___________ Zip: _____________________

Mother's phone: ______________________________________________________________________________________ Father's phone: ____________________________________________________________________________________

Email: ______________________________________________________________________________________________________________________________________________________________________________________________________________________

MEDICAL/spaceliningINFORMATION

Person to contact in case of emergency if parents cannot be reached: ______________________________________________________________________________________________________________

Phone(s): ______________________________________________________________________________________ Relationship to child: _______________________________________________________________________________________

Doctor's name: __________________________________________________________________________________________________________ Phone number: ___________________________________________________________________

Emergency room of choice: ___________________________________________________________________________________________________________________________________________________________________________________

Allergies, medications, special conditions including but not limited to asthma, diabetes, sun sensitivity, seizures or fainting spells (please

provide specifics): ___________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PAYMENT/spaceliningINFORMATION

Person responsible for payment: ___________________________________________________________________________________________________________________________________________________________________________

Responsible party's address: _________________________________________________________________________________ City: ___________________________________________ State: _________ Zip: ________________

Day phone: _____________________________________ Evening phone: ______________________________ Email address: ______________________________________________________________________________________

Method of Payment (Indicate your choice by completing the appropriate information below):

For security reasons, your payment information will be encrypted by our computer so/ftware and this information will be shredded.

LRRC/LRAC club account option (for members only/account must be current)

Name of member to be charged: ____________________________________________________________________________________________________________________________________________________________

Credit/debit card option (Visa, MasterCard, Discover, American Express)

Name as shown on card: __________________________________________________________________________________________________________________________________________________________________________

Credit card number: ______________________________________________________________________________________ Expiration date: ___________________________ CCV number: ___________

To be completed by LRRC staff

Date: ____________________________

Staff initials: _________________

NOW/spaceliningSIGN/spaceliningTHE/spaceliningW AIVER/spacelining ON/spaceliningTHE/spaceliningBA CK

RELEASE OF LIABILITY & ASSUMPTION OF RISK AGREEMENT

I understand and acknowledge that this is an agreement between myself and the auspices of the Li/ttle Rock Athletic Centers, LLC, dba Li/ttle Rock Athletic Club, Li/ttle Rock Racquet Club, North Li/ttle Rock Athletic Club and Downtown Athletic Club (collectively referred to as LRAC). I further acknowledge that I have the ability to read and have been provided the opportunity to read this agreement before signing.

I understand and agree that being allowed to participate and utilize the equipment, programs, supplies, services, staff and facilities at LRAC is good and valuable consideration for this agreement.

I understand that the nature of LRAC's facilities and equipment contemplate that other members, guests and staff will have access to the equipment, supplies and services available at LRAC. While LRAC takes reasonable steps to insure the safety and sanitization of the equipment, programs, supplies, services and facilities, it cannot and does not guarantee that the equipment, programs, supplies, services and facilities are germ / virus free (this includes, but is not limited to COVID-19). I acknowledge the individual responsibility regarding these issues and hereby waive any and all claims related to such issues should I or my children choose to participate and/or utilize the equipment, programs, supplies, services and facilities. I also acknowledge the individual responsibility regarding the fact that other members, guests or staff may be present and may have medical conditions and/or infections wholly independent of LRAC. I hereby waive any and all claims related to such issues should I or my children choose to participate and/or utilize the equipment, programs, supplies, services and facilities while other members, guests or staff are present.

RELEASE AND AGREEMENT NOT TO SUE: I understand, acknowledge and agree that the equipment, programs, supplies, services and facilities at LRAC are voluntary and that they involve inherent risks. The risk of injury includes the risk of use and the risk of misuse. The possible injuries include the potential for permanent paralysis and death. I knowingly and freely assume all such risks, both known and unknown and assume full responsibility for my participation and that of my children. I knowingly and freely agree to waive any claim for injury sustained at LRAC and agree not to sue LRAC (including its managers, officers, officials and/or employees) whether or not the claim for injury was caused by the negligence of LRAC, its managers, officers, officials and/or employees. I further agree to indemnify and hold harmless LRAC against any and all damage, loss, cost and expense related to any injury or harm I or my children might sustain.

Photography and/or Video - I understand that LRAC periodically takes facility and group photographs and videos and uses the resulting content for lawful purposes including, publicity, illustration, advertising and web content. I grant to LRAC and all its subsidiaries the right to take photographs and/or videos of myself or my children. I authorize LRAC, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that LRAC may edit and use such photographs and/or videos for any lawful purpose..

Text and Email Communication - By opting in to receiving text and email messages from LRAC, I agree to allow LRAC and all its subsidiaries, agents and service providers to contact me with promotional and informational texts and emails at the phone number(s) and/or email address(es) provided. I acknowledge that providing these phone numbers and email addresses is not a condition of receiving any property, goods or services. By listing this information, I certify that it is accurate and that I own the rights to use it and give consent for it/their use. Additionally, I understand that I may unsubscribe at any time to these communications.

PARICIPANT/spaceliningAGREEMENT

MY/spaceliningSIGNA TURE/spaceliningCONVEYS/colonlining

• I have read all of the above, fully understand its meaning and that I have given up substantial rights and granted specific permissions which I do freely and voluntarily without any inducement or coercion.
• I give my consent for my child to receive medical or surgical aid as may be deemed necessary and expedient by a duly licensed or recognized physician or surgeon in the case of an emergency when a parent or guardian cannot be reached. Consent is also given for an LRAC employee or his/her duly appointed representative to transport my child for emergency medical treatment in said situation;
• I authorize the LRAC to dra/ft the Child Consent fee;
• I understand the Rules and Regulations explained herein and my child agrees to abide by them.

Print Parent's/Guardian's Name: __________________________________________________________________________________________________________________________________________________________________________

Parent's/Guardian's Signature: ____________________________________________________________________________________________________________________

Date: __________________________________________

Print Child's Name: ________________________________________________________________________________________________________________________________________________________________________________________________

Child's Signature: ____________________________________________________________________________________________________________________

Date: __________________________________________________________