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Swimming Consent Form
For Maple Class starting 27th April
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* Indicates required question
Child's Name:
*
Your answer
Your Name:
*
Your answer
Name of family doctor
*
Your answer
Telephone Number of Doctor's Surgery
*
Your answer
Address of Doctor's Surgery:
*
Your answer
Is your child able to swim for 50 metres
*
Yes
No
Other:
Is your child water confident in a pool?
*
Yes
No
Other:
Is your child safety conscious in water?
*
Yes
No
Other:
I would like my child to take part in weekly swimming lessons and having read the information provided, agree to them taking part in the activities described.
*
Yes
No
I consent to any emergency medical treatment required by my child during the course of the visit
*
Yes
No
I confirm that my child is in good health and I consider them fit to participate
*
Yes
No
Required
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