2019 Dunedin Swim Consent Form For Water Activities for every child

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Ao Tawhiti Unlimited Discovery EOTC procedures requires specific parental/ caregiver consent be given for every child in situations where swimming or water activities occur. Please fill a separate form in for every child on camp. Thanks :)

Swimmer Information : Child's name and age, ie. Sam Gill Vine 8 *

Is able to tread water *

Yes

Is able to survival float *

Yes

Is confident in a swimming pool *

Yes

Is confident in deep water *

Yes

Is able to swim 50 metres confidently *

Yes

Is confident in the sea or in the open inland water *

Yes

I give my child permission to be involved in water activities if they are ACTIVELY supervised by an adult with a 1:4 ratio. *

Yes

I consent to any emergency treatment required by my child or myself during the course of the event should it be required. *

Yes

I confirm my child is in good health and I consider them fit to participate in supervised water based activities *

Yes

Additional comments and information relevant to the activity.

Parent's name and date, (this will also become your signature in this online document.) *

Parent's cellphone and daytime contact number. *

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