Swimming Permission Form

Swimming Permission Form
Ages 11-14 independent swimmers | Declaration for parent/guardian
Parent/Guardian Name
First NameLast Name
Is there any applicable other Parent/Guardian?
YesNo
Parent/Guardian Name #2
First NameLast Name
Primary Contact Email
example@example.com
Primary Contact Phone Number
Please enter a valid phone number.
Member's Name
First NameLast Name
In consideration of being permitted to utilize the pool as described herein, I for myself and such participating children and any personal representatives, heirs, and next of kin, release and agree to hold harmless ACME Swim Club, its board, agents and employees for all incidents alleging bodily injury or property damage or loss occurring while the above child is at ACME Swim Club without a parent/guardian. I will not hold harmless ACME Swim Club from any liability arising out of negligence of ACME Swim Club.
Parent/Guardian Signature
Clear
Date
ⁱ⁾ A new Permission form must be completed for each swimming season.
Should be Empty: