Please list any additional adults living with you in your home, along with their phone numbers.

Please list name and phone number for your main emergency contact.

Please provide a detailed list of minor children living with you in your home, their birthdates, and emergency contact for each child. If all children have the same emergency contact, you only need to list it once.

Please list the children who are allowed to be at the pool unaccompanied by an adult. Unaccompanied children must be at least 10 years old and must first pass a swim test before being allowed to be unaccompanied by an adult. Children under the age of ten must be accompanied by an adult.

I give the above listed children permission to swim and use the facilities of the Beechwood Recreation Association in my absence. I give the staff of the Beechwood Recreation Association permission to seek emergency medical attention if necessary. By checking "yes" on this form, I am giving my permission for my children to swim unaccompanied at Beechwood Pool.

Please list any allergies or medical conditions for any of your family members. Be sure to include their name.